Thank you for choosing Nava for your wellness needs. We look forward to serving you and helping you on your wellness journey. These terms are provided by Nava Health MD, LLC and Nava Health Medical Group, LLC (operating under the Nava name).
TERMS CONCERNING HEALTH MAINTENANCE ORGANIZATIONS
If you are a member of any Health Maintenance Organization (HMO), you agree that you have been informed that for the majority of services offered by Nava, neither Nava nor any Nava practitioners (when providing services on behalf of Nava) are participating providers with your HMO and that if you obtain any Nava services/products, you will be billed at Nava’s usual rates and you will be responsible for full payment of all Nava charges. You agree that if you obtain treatment from another healthcare provider who does participate in your HMO and that service is covered by your HMO, you would be entitled to reimbursement from your HMO as provided by the terms of your HMO plan.
YOU THEREFORE ACKNOWLEDGE AND AGREE THAT:
• YOU WILL BE SOLELY RESPONSIBLE FOR ALL NAVA CHARGES FOR SERVICES RENDERED BY NAVA AND NAVA PRACTITIONERS, AND
• NEITHER NAVA NOR ANY NAVA PRACTITIONER WILL SEEK PAYMENT FROM YOUR HMO FOR ANY SERVICES YOU RECEIVE AT NAVA.
Who We Are
Nava offers a variety of wellness services. The Nava team includes physicians and other healthcare practitioners licensed in the state where services/products are provided, along with other Nava staff who do not require any type of licensing (Nava’s general nutrition services are non-medical and are not provided in connection with the treatment of any particular medical condition). NAVA SERVICES/PRODUCTS ARE NOT A SUBSTITUTE AND YOU SHOULD DISCUSS ANY WELLNESS PROGRAM WITH YOUR PRIMARY CARE PHYSICIAN.
Keeping Us Informed
Nava seeks to develop wellness through collaborative, open communications with our clients. You agree to let Nava staff know of any disease or condition or any drug or supplement you are taking that may relate to the effectiveness of or interfere with any Nava services/products.
Understanding Your Payment Options
For certain services offered by Nava, we do not accept insurance or file claims with any insurance providers, including government providers such as Medicare and/or Medicaid. For services where we will not file claims with any insurance providers, as a convenience to you, we will provide you with summary information listing any Nava services/products that you receive. Unless applicable, Nava practitioners are in-network with your insurance provider (or out-of-network for certain services where your insurance provider offers some coverage for such services*), you agree that: (a) we have not indicated that any Nava services/products will be covered by any insurance or other benefits, and (b) we have not recommended that you submit any Nava charges to any insurance or other provider for reimbursement. For such services, you will be responsible for the full Nava charges for all Nava services/products that you receive, even if your insurance provider pays for similar services/products at a lower rate or denies the claim. Payment in full must be made at the time of service/purchase. Certain services/products may require a non-refundable deposit. If you provide a credit card, we may charge any credit card on file for services/products that you receive, including any responsibility portion where applicable Nava practitioners are in-network with your insurance provider (or out-of-network for certain services where your insurance provider offers some coverage for such services*).
*One or more Nava practitioners may be out-of-network providers under certain insurance plans, and certain services performed by Nava or on behalf of Nava may be submitted to your insurance plan for reimbursement. Nava will inform you at the time of service if any service you obtain will be submitted to your insurance plan for reimbursement.
Use of Pre-Paid Packages
If you pre-pay for any Nava package, you must use your complete package within one year of your pre-payment (for all pre-paid packages except Nava nutrition packages, which you must use within six months of your pre-payment). We may change these terms at any time and will post notice of any changes on our website. By continuing to pay for and/or use any Nava services, you agree to any such changes.
Our Cancellations Policy
We value our clients’ time and schedule appointments in an effort to best allocate Nava staff resources so that clients receive prompt, thorough service. We ask that you honor all Nava appointments, and if for some reason you will not be able to do so, you must give us as much advance notice as possible. You may cancel an appointment or reschedule it so long as you do so by calling us at least 24 hours in advance of the scheduled time of a particular appointment. If you do not provide at least 24 hours advance notice, you agree to pay a $100 fee for a missed medical appointment or a $75 missed appointment fee for a non-medical appointment. This fee will be charged to your credit card on file or collected at your next appointment (if no credit card is on file). Pure Radiance/Sexual Vitality services require 72-hour advance notice, or the $500 deposit will be forfeited.
How We Will Communicate With You
Use of Telephone:
If you provide us with a telephone number, we may contact you using that telephone number to discuss your Nava wellness services, appointments, records, and purchases.
Use of Electronic Communication Methods:
Electronic communications include email messages, internet communication services (such as Skype™), or other electronic methods. You agree that electronic communications are not secure and that there is the possibility that they may be accessed by other persons. You also agree that your employer may review any electronic communications transmitted through your employer’s computer system. We may use email or other electronic communications to transmit routine information to you (such as appointment dates, newsletters, etc.). We may also use email or other electronic communications to transmit information concerning your Nava services and products unless you tell us otherwise (as described below).
If you give us an email address or communicate with us using other electronic communications, you agree that:
(a) electronic communications should not be used for emergency or other time-sensitive situations or where sensitive information will be transmitted (please contact us by telephone or visit a Nava location);
(b) we will use reasonable efforts to respond to electronic communications that you send (if you do not hear from us within two business days, please contact us by telephone or visit a Nava location) and we will not be liable for any failure to respond or any intercepted electronic communications;
(c) one or more Nava staff members may need to access your electronic communications in order to help Nava respond; and
(d) Nava may keep copies of electronic communications that you send in your client records.
By providing your mobile and/or home number (including any phone number that you later convert to a mobile phone number) to us through any request for services or otherwise, you consent to receive informational calls, text messages (including by auto dialers and/or with pre-recorded messages) by or on behalf of us regarding the processing of your request and for other transactional purposes. You understand that your consent for non-marketing, informational calls and messages applies to each phone number that you voluntarily provide to us now or in the future.
If you do not wish Nava to use electronic communications to transmit information concerning your Nava services/products, you can provide written notice to us at: firstname.lastname@example.org or 9755 Patuxent Woods Drive, Suite 100, Columbia, MD 21046.
What If There Were Ever A Disagreement Between Us?
By agreeing to the Nava New Client Terms/Notices, you agree that any claim or dispute between you and Nava (or any parent, subsidiary, affiliate, successor or assignee, officer, director, employee, agent, or representative of you or Nava) arising from or relating to your relationship with Nava and/or the services that you obtain from Nava must be resolved by binding arbitration following these arbitration terms and the Commercial Dispute Resolution Procedures and Supplementary Procedures for Consumer-Related
Disputes of the American Arbitration Association (AAA). If the AAA is unavailable or unwilling to serve as administrator, a substitute administrator will be selected by either: (a) our mutual agreement or
(b) if we cannot agree by a court.
You may get the AAA rules and forms by writing, calling, or emailing: American Arbitration Association, 335 Madison Avenue, Floor 10, New York, New York 10017, 800-778-7879, www.adr.org. Any arbitration will take place in the county where you live. If a substitute arbitration administrator is appointed, we will provide contact information for the substitute administrator.
You will pay an administrative fee and an arbitrator’s fee. The AAA caps your fees depending on the amount of any claim that you file. Nava is responsible for administrative fees and arbitrator’s fees in excess of the capped amounts. If you ask Nava in writing, Nava will pay the entire administrative fee and arbitrator’s fees. Nava and you will pay each of our attorneys, experts and other fees, except as otherwise provided by law.
No class actions, etc. Nava and you also agree that the arbitrator only may resolve the claims, disputes, or controversies between Nava and you. The arbitration won’t be conducted on a class-wide basis or be consolidated with claims or demands of other persons. You agree not to participate in a representative capacity or as a member of any class of claimants pertaining to any claim.
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice is provided by Nava Health MD, LLC and Nava Health Medical Group, LLC, each doing business under the “Nava Health & Vitality Center” name, as well as all Nava physicians, nurses, and other personnel (Nava).
This Notice applies to all Nava services you obtain at any Nava location.
Nava Privacy Obligations
We are required by law to maintain the privacy of your protected health information (“PHI”), to provide you with this Notice, and to notify you following a breach of any unsecured PHI. When we use or disclose your PHI, we are required to follow the terms of this Notice, as it may be amended.
Uses and Disclosures Without Your Written Authorization
In certain situations (described below), we must obtain your written authorization to use and/or disclose your PHI, but we do not need any authorization from you to use or disclose your PHI:
- In connection with treatments you request (including disclosures to health care providers involved in your treatment).
- To obtain payment for services that we provide to you.
- For our health care operations, including internal administration and planning and various activities that improve the quality and cost-effectiveness of the services that we deliver to you (all Nava entities/providers are part of an organized health care arrangement and will share PHI with each other to carry out treatment, payment, or health care operations).
- For health care fraud and abuse detection or compliance.
To a family member, other relative, a close personal friend, or any other person you identify, if we (1) obtain your agreement; (2) provide you with the opportunity to object (and you do not object); or (3) reasonably infer that you do not object to the disclosure (in case of incapacity or emergency we can exercise our professional judgment).
To a family member, other relative, a close personal friend, or any other person you identify to provide notice of your location, general condition, or death.
For the following public health activities:
(1) to report health information to public health authorities prevent or control disease, injury, or disability;
(2) to report child abuse and neglect to public health/government authorities authorized by law to receive such reports;
(3) to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration;
(4) to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition and (5) to report information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance.
To a governmental authority (including a social service or protective services agency) authorized by law to receive reports of abuse, neglect, or domestic violence.
To a health oversight agency that oversees the health care system and is charged with responsibility for ensuring compliance with the rules of government health programs such as Medicare or Medicaid.
In the course of a judicial or administrative proceeding in response to a legal order or other lawful process.
To the police or other law enforcement officials as required or permitted by law or in compliance with a court order or a grand jury or administrative subpoena.
To a coroner or medical examiner as authorized by law.
To organizations that facilitate organ, eye or tissue procurement, banking, or transplantation.
To prevent or lessen a serious and imminent threat to a person’s or the public’s health or safety.
To units of the government with special functions, such as the U.S. military or the U.S. Department of State, under certain circumstances.
As authorized by and to the extent necessary to comply with state law relating to workers’ compensation or other similar programs.
When required to do so by any other law not already referred to in the preceding categories.
Use or Disclosure with Your Authorization
We must obtain your written authorization for most uses and disclosures of PHI for marketing purposes and disclosures that constitute the sale of PHI and for any other uses and disclosures not described in this Notice (Authorization).
Revocation of Your Authorization
You may withdraw (revoke) your Authorization (except to the extent that we have taken action in reliance upon it) by delivering a written statement to the Privacy Officer identified below.
For Further Information: Complaints
If you would like more information about your privacy rights, if you are concerned that we have violated your privacy rights, or if you disagree with a decision that we made about access to your PHI, you may contact our Privacy Officer. You may also file written complaints with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. Upon request, the Privacy Officer will provide you with the correct address for the Director. We will not retaliate against you if you file a complaint with us or the Director.
Right to Request Additional Restrictions
You have the right to request a restriction on the uses and disclosures of your PHI (1) for treatment, payment, and health care operations purposes, and (2) to individuals (such as a family member, other relative, close personal friend, or any other person identified by you) involved in your care or with payment related to your care. Unless otherwise required by law, we are required to comply with your request for this type of restriction. For all other requests for restrictions on use and disclosures of your PHI, we are not required to agree to your request but will attempt to accommodate reasonable requests when appropriate. If you wish to request additional restrictions, please contact our Privacy Officer.
Right to Receive Confidential Communications
You may request, and we will accommodate, any reasonable written request for you to receive your PHI by alternative means of communication or at alternative locations.
Right to Inspect and Copy Your Health Information
You may request access to your client file and billing records maintained by us to inspect and request copies of the records. Under limited circumstances, we may deny you access to a portion of your records. If you would like to access your records, please contact our Privacy Officer. If you request copies, we will charge you a cost-based fee, consistent with applicable state law.
Right to Amend Your Records
You have the right to request that we amend PHI maintained in your client file or billing records. If you desire to amend your records, please contact our Privacy Officer. We will comply with your request unless we believe that the information that would be amended is accurate and complete or other special circumstances apply.
Right to Receive An Accounting of Disclosures
Upon request, you may obtain an accounting of certain disclosures of your PHI made by us during any period of time prior to the date of your request, provided such period does not exceed six years. If you request an accounting more than once during a twelve (12) month period, we will inform you in advance of any fee and provide you with an opportunity to withdraw or modify the request.
Right to Receive A Copy of this Notice
Upon request, you may obtain a copy of this Notice, either by email or paper format, by submitting a request to our Privacy Officer.
Effective Date: Right to Change Terms of this Notice
This Notice is effective on November 15, 2015. We may change the terms of this Notice at any time, and if we do, we can make the new terms apply for all PHI that we maintain (including PHI created or received before the change). If we change this Notice, we may make the new notice terms effective for all Protected Health Information that we maintain, including any information created or received prior to issuing the new notice. If we change this Notice, we will post the new notice in Nava locations and on our Internet site at www.navacenter.com. You also may obtain any new notice by contacting the Privacy Officer.
VII. Privacy Officer
You may contact the Privacy Officer at Privacy Officer (designated for all Nava entities); Nava Health and Vitality Center; 9755 Patuxent Woods Drive, Suite 100; Columbia, MD 21046; Phone: (410) 910-2853.
NOTICE OF PRIVACY PRACTICES CLIENT ACKNOWLEDGMENT
Our Notice of Privacy Practices (“Notice”) provides information about (1) the privacy rights of our clients; and (2) how we may use and disclose protected health information about our clients.
Federal regulations require we give our clients or their authorized representatives our Notice before signing this acknowledgment.