Treatment Policy

Please be aware that we collect estimated insurance portions at each visit. Your insurance policy is a contract between you and your insurance company. You are responsible for any unpaid balances, regardless of the original estimate of the insurance benefit. As a courtesy to you, we will file your claims with your insurance company. Insurance payments are usually received within 30-45 days. Any unpaid balances after 60 days are your responsibility and are due at that time. All deductibles and co-payments are due at the time of service.  A copy of your insurance card will need to be kept on file in our office.  You are providing consent to services provided in person or via a secure telehealth platform.  Patients with chronic conditions are enrolled in Chronic Care Management and Remote Patient Monitoring program to provide more comprehensive care and anticipate worsening.  You may discontinue at any time, but it has proven beneficial in making better-informed decisions and preventing complications.  AI technology is incorporated for quality control, data analysis, and documentation efficiency, not for clinical judgement.  A care plan is created and available for review. The care plan includes the patient’s problem list, expected outcome, treatment goals, symptom management, planned interventions, medication management, social services if ordered, and periodic revision of the care plan.  We try to answer any questions you may have about your insurance company, however, you may need to contact your insurance company for additional information. If your insurance changes, it is your responsibility to provide updated information to our office.  Please be aware of your insurance policy regarding a deductible.  The deductible is usually required at the beginning of each calendar year which is payable before benefits are covered.      

Assignment of Benefit

Please read and sign to have our office file your insurance: I authorize the release of information and understand that I am responsible for all costs of medical treatment. I hereby authorize payment directly to George Valdez, MD of the insurance benefits otherwise payable to me.

HIPAA Consent and Acknowledgment

Notice of Privacy Practices. I acknowledge that I have received the practice’s Notice of Privacy Practices, which describes the ways in which the practice may use and disclose my healthcare information for its treatment, payment, healthcare operations and other described and permitted uses and disclosures, I understand that I may contact the Privacy Officer designated on the notice if I have a question or complaint. To the extent permitted by law, I consent to the use and disclosure of my information for the purposes described in the practice’s Notice of Privacy Practices.

Release of Information. I hereby permit practice and the physicians or other health professionals involved in the inpatient or outpatient care to release healthcare information for purposes of treatment, payment, or healthcare operations. Healthcare information may be released to any person or entity liable for payment on the Patient’s behalf in order to verify coverage or payment questions, or for any other purpose related to benefit payment. If I am covered by Medicare or Medicaid, I authorize the release of healthcare information to the Social Security Administration or its intermediaries or carriers for payment of a Medicare claim or to the appropriate state agency for payment of a Medicaid claim. This information may include, without limitation, history and physical, emergency records, laboratory reports, operative reports, physician progress notes, nurse’s notes, consultations, psychological and/or psychiatric reports, drug and alcohol treatment and discharge summary. Federal and state laws may permit this facility to participate in organizations with other healthcare providers, insurers, and/or other health care industry participants and their subcontractors in order for these individuals and entities to share my health information with one another to accomplish goals that may include but not be limited to: improving the accuracy and increasing the availability of my health records; decreasing the time needed to access my information; aggregating and comparing my information for quality improvement purposes; and such other purposes as may be permitted by law. I understand that this facility may be a member of one or more such organizations.