201 N. 1st St, Suite A, Burbank, CA 91502
Tel (818) 846-6622 Fax (818) 846-6222

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Patient Forms & Documents

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Frequently Asked Questions

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Health Insurance Portability and Accountability Act

Frequently Asked Questions

In a constantly changing healthcare environment, our practice is committed to educating our patients about healthcare issues that affect them. As a result, we have provided below general information about the Health Insurance Portability and Accountability Act of 1996 (HIPAA) for your review. Our practice is complying with HIPAA’s regulations and would be happy to answer any additional questions you might have.

What is the Privacy Rule?

The Privacy Rule is part of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The Privacy Rule establishes a federal requirement that doctors, hospitals or other healthcare providers and health plans obtain a patient’s written consent before using or disclosing a patient’s personal health information to carry out treatment, payment or healthcare operations.

Media City Medical LLC is required by law to be compliant with the Privacy Rule by April 14, 2003

What is PHI?

PHI or protected health information means any personal health information as defined by law, including demographic information that is collected from a patient by a healthcare provided or other entity that could potentially identify the individual. PHI includes all medical records and other individually identifiable health information held or disclosed by Media City Medical LLC regardless of how it is communicated (e.g. electronically, written, verbally).

What is TPO?

TPO refers to the treatment, payment or healthcare operations of Media City Medical LLC.

In other words, our practice can use or disclose PHI for performing any activity that it deems necessary for 1) providing quality patient care, 2) ensuring that our practice gets paid for services, and 3) operating our practice. Some examples of these activities are use of PHI by the physician(s) and clinical staff to treat a patient, use of PHI by the business office staff to verify insurance information for billing purposes, use of PHI to obtain a referral, and use of PPI for our practice’s business planning and internal management activities.

Why Do I Have To Sign A Consent Form?

In order to use or disclose your PHI, our practice is required to obtain a signed consent form from you to directly treat you or carry out healthcare payment and operations activities. Our practice is not required to obtain your prior consent in an emergency, when our practice is required by law to treat you, or when there are substantial communication barriers. Our practice reserves the right to refuse to treat you if you do not sign the consent form.

What is the Difference Between the Consent and Authorization Forms?

In order to use or disclose your PHI for specified purposes other than direct treatment, payment, or healthcare operations, our practice is required to obtain a signed authorization form from you. For example, if you request our practice to disclose PHI to a third party, you must sign an authorization form. This authorization form is more detailed than a consent form and has a specific expiration date.


Office Policy

Frequently Asked Questions

Same day Appointments?

We do offer same day appointments for acute care needs if appointment space is available.

How can I reach my provider?

It is our policy to address all telephone calls as soon as possible. The office staff has been trained to answer many of your questions. If they cannot answer your question, they will obtain an answer from your Provider and return your call as soon as possible. Someone is available 24/7; for afterhours emergent/urgent queries, please call our phone at 818-846-6622 and our answering service will page the physician on-call. Please note that lab results and prescription refills are not available through the office or by telephone during evening and weekend hours.

What if I need Emergency Care?

Emergencies should be handled in accordance with the guidelines provided by your insurance company. In the event of a life threatening emergency, you should call 911 and/or go to the nearest hospital emergency room and have them notify your family physician upon your arrival. After-hours telephone service is available by calling our main number. Our answering service will receive your call and page the doctor on-call if you have a medical need that cannot wait until the next business day. On-call physicians will not be able to provide you with routine medication refills and do not have access to your chart.

What is your Insurance and Financial Policy?

We accept most major insurance plans including Medicare. We will submit a claim to your insurance company after your appointment. Your insurance company determines the amount of your coverage and you should be aware of your benefits. If you have questions regarding your insurance coverage, you should contact your insurance representative. Payments for all non-covered portions of the visit, including co-pays are payable at the time of service. Payments may be made by cash, check or credit card. If we do not participate with your insurance plan, we ask that you pay in full at the time of service.

Change in Insurance?

Please be advised that our office has no way of knowing if you’ve had a change in your medical insurance and/or health plan. It is the responsibility of the patient to provide updated insurance information to our office as soon as they become effective and prior to services being rendered. Failure to do so will delay claims and possibly result in a denial of services. The patient will still be held responsible for payment of the provided services.

What if I need a prescription refill?

Prescriptions and refills are issued during office hours only. Most of the time, we allow enough refills to last until your next scheduled appointment. Please try to call for refills 48-72 hours prior to the time your refill is needed.

Do you do routine GYN care, including Pap tests?

We are a full care, comprehensive clinic. We perform routine Pap tests (with HPV testing), breast exams, and can prescribe birth control options. We also deal with frequent problems such as vaginitis, pelvic pain, menstrual irregularities, and menopausal symptoms.

Can you see my entire family?

We see people ages 16 and above.

Can I see you even if you do not participate with my health insurance?

Even if we do not participate with your health insurance, we are happy to provide you care. You are responsible for payment at the time of service.

How do I obtain a Specialist Referral?

Many insurance companies require you to be evaluated by your primary care physician to determine the need for a referral to a specialist. If needed, our office will complete a referral to your insurance and may require insurance authorization prior to your ability to make an appointment with the specialist.

How can I obtain a copy of my medical records?

Your medical record is confidential and important to us. It will not be given to anyone without your written consent. You must sign a release of information form before we can release your medical records. If you wish for particular family members to be able to access your medical information, you will be required, in writing, to allow release of your medical records to the desired individual. Forms are available in our office.

What is your cancellation policy?

Our office employs a 24 hour cancellation policy. This applies to both cancellations and to changes in appointments. As a courtesy to your fellow patient, please call us ahead of time so that we can provide your slotted appointment time to someone else. A $25 fee will be applied if the above policy is not complied with. We reserve the right to terminate our relationship as a result of repeated missed appointments. If you are going to be more than 15 minutes late, we may have to reschedule your appointment so that your tardiness does not interfere with patients that arrived on time.