Return Patient Scheduling App (iPhone)
Online Forms
- Adult or Pediatric Online – Patient Health History **Preferred Method**
- Print Paperwork at Home – New Adult Patient Health History
- Print Paperwork at Home – Pediatric – Patient Health History
Return Patient Scheduling App (Android)
Utilizing your insurance provides a network discount on the doctor’s normal fees. For example, if your plan covers chiropractic care you may have a copay, co-insurance or deductible that is your portion due at time of service.
If you have a deductible plan, you pay your discounted insurance portion (agreed rate between insurance and the provider) and that is applied to your deductible for the year. Once your deductible is met, in most cases they will pay a percentage of each visit and you pay the remainder. This happens until your out of pocket is met, at that point they cover 100%.
If your plan has a co-pay, you have a set amount each visit that you pay and insurance covers the remainder. Some plans have a $10 copay while others have a $45 copay.
Copay, deductible or co-insurance are due at the time of service unless other arrangements have been made.
As always it is best to check with your insurance on what your coverage benefits are and to determine if the doctor is in-network for your specific PPO plan. You may also provide a copy of your insurance information to be checked prior to your appointment or at time of service and the office will be glad to check your benefits for you. *Final determination of claims is always provided by your insurance.
Common services that may be covered by your insurance include examination and re-examination, chiropractic manipulation, physiotherapy modalities such as Ultrasound, Intersegmental Traction, Interferential Muscle Stimulation, Cold Laser and in some cases Acupuncture.
Our providers are in-network with United Health Care. Medicare and Medicaid are also accepted for your convenience.
Schrage Chiropractic offer reasonable rates for chiropractic and acupuncture services. Patients that require a discount beyond our normal fees have the option of joining ChiroHealthUSA. This plan costs $49 annually and allows providers to legally discount our rates like an insurance plan does.
Please visit Patients | ChiroHealthUSA to learn more!
In order to keep inventory at its freshest state, Dr. Jen is excited offer an online portal for your convenience. Simply register for the portal and you will receive FREE Shipping on orders over $49!
Dr. Jen Howard’s Wellevate Patient Portal
HIPAA 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 CAREFULLY.
Uses and Disclosures: We will use and disclose elements of your protected health information (PHI) in the following ways:
Without your signed authorization:
- Treatment
- Payment
- Health care operations
- When release is required by law, including in judicial settings and to health oversight regulatory agencies and law enforcement.
- In emergency situations or to avert serious health/safety situations.
- To medical examiners, coroners or funeral directors to aid in identifying you or to help them in performing their duties.
- To organ, tissue and other donation organizations, upon or proximate to your death if you have no indication on hand about your donation preferences.
Special cases
- To contact you about appointment reminders, treatment alternatives and other health related benefits and services.
- To the sponsor of your health plan.
Other
- All other uses and disclosure by us will require us to obtain from you a written authorization in addition to any other permission you will provide us.
Your rights: You have the following rights concerning your PHI:
Restrictions: To request restricted access to all or part of your PHI. We are not required to grant your request.
Confidential communications: To received correspondences of confidential information by alternate means or location.
Access: To inspect or receive copies of your protected health information.
Amendments: To request changes be made to your PHI. We are not required to grant your request.
Accounting: To receive an accounting of the disclosure by us of your PHI in the six years prior to your request.
This notice: To get updates or reissue of this notice, at your request.
Complaints: To complain to us or the U.S. Dept. of Health & Human Services if you feel your privacy rights have been violated. The law forbids us from taking retaliatory action against you if you complain.
Our Duties: We are required by law to maintain the privacy of your PHI. We must abide by the terms of this notice or any update of this notice.
Martin & Schrage Chiropractic is in compliance with the HIPAA Omnibus Rule. Martin & Schrage Chiropractic will not disclose Private Health Information without authorized permission from a patient. Private Health Information would be used/disclosed with authorized permission for marketing purposes. If you do not give express permission, we will not use your information for marketing purposes. If a patient requests a digital copy of certain electronic Private Health Information or directs Dr. Howard in writing to transmit a copy to another person, Dr. Howard will produce the information in the format requested (if readily producible) within 30 days or negotiate an alternative format. Further, if a patient requests that a copy of his or her Private Health Information be sent via unencrypted email, the Dr. Howard will be permitted to do so, providing that the patient is aware of the risks and prefers the unencrypted email. Please be aware that Dr. Howard has the means to send some Private Health Information via encrypted email. If a patient would prefer an encrypted email, please inform a Martin & Schrage Chiropractic Staff Member.
As a patient, you have a right to restrict any disclosures made to health plans for payment or health care operations purposes if the Private Health Information pertains to an item or service for which you paid COMPLETELY out of pocket.
Martin & Schrage Chiropractic has completed a Risk Assessment regarding Private Health Information and has found no breaches in security. If in the event a breach occurs Martin & Schrage Chiropractic will inform affected patients and perform another Risk Assessment to address any changes that need to be made. Martin & Schrage Chiropractic takes the protection of Private Health Information very seriously and maintains strict compliance with any and all HIPAA requirements.
To read the HIPAA Omnibus Rule in its entirety and how it may pertain to you please visit: http://www.gpo.gov/fdsys/pkg/FR-2013-01-25/pdf/2013-01073.pdf