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Home » Quality Vision Care Privacy Practices HIPAA Policy and Insurance Practices

Quality Vision Care Privacy Practices HIPAA Policy and Insurance Practices



Notice Revised and Effective: January 12, 2023

THIS NOTICE OF PRIVACY PRACTICES (“NOTICE”) DESCRIBES HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION AND HOW YOU CAN GET ACCESS TO SUCH INFORMATION. PLEASE READ IT CAREFULLY. Your “health information” for purposes of this notice, is generally any information that identifies you and is created, received, maintained or transmitted by us in the course of providing health care items or services to you (referred to as “health information” in this Notice).

We are required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and other applicable laws to maintain the privacy of your health information, to provide individuals with this Notice of our legal duties and privacy practices with respect to such information, and to abide by the terms of this Notice. We are also required by law to notify affected individuals following a breach of their unsecured health information.


The most common reasons why we use or disclose your health information are for treatment, payment or health care operations. Examples of how we use or disclose your health information for treatment purposes are: setting up an appointment for you; testing or examining your eyes; prescribing glasses, contact lenses or eye medications and faxing them to be filled; showing you low vision aids; referring you to another doctor or clinic for eye care or low vision aids or services; or getting copies of your health information from another professional that you may have seen before us. Examples of how we use or disclose your health information

for payment purposes are: asking you about your health or vision care plans, or other sources of payment; preparing and sending bills or claims; and collecting unpaid amounts (either ourselves or through a collection agency or attorney). “Health care operations” means those administrative and managerial functions that we must carry in order to run our office. Examples of how we use or disclose your health information for health care operations are: financial or billing audits; internal quality assurance; personnel decisions; participation in managed care plans; defense of legal matters; business planning; and outside storage of our records.


In some limited situation, the law allows or requires us to use or disclose your health information

without your consent or authorization. Not all of these situations will apply to use; some may never come up at our office at all. Such uses or disclosures are:

  • When a state or federal law mandates that certain health information be reported for a specific purpose
  • For public health purposes, such as contagious disease reporting, investigation or surveillance; and notices to and from the federal Food and Drug Administration regarding drugs or medical devices.
  • Disclosures to governmental authorities about victims of suspected abuse, neglect, or domestic violence;
  • Uses and disclosures for health oversight activities, such as for the licensing of doctors; for audits by Medicare or Medicaid; or for investigation of possible violations of health care laws;
  • Disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of courts or administrative agencies
  • Disclosures for law enforcement purposes, such as to provide information about someone who is or is suspected to be a victim of a crime; to provide information about a crime at our office; or to report a crime that happened somewhere else;
  • Disclosures to a medical examiner to identify a dead person or to determine the cause of death; or to funeral directors to aid in burial; or to organizations that handle organ or tissue donations;
  • Uses or disclosures to health related research;
  • Uses and disclosures to prevent a serious threat to health or safety;
  • Uses or disclosures for specialized government function, such as for the protection of the president or high ranking government officials; for lawful national intelligence activities; for military purposes; or for the evaluation and health of members of the foreign service;
  • Disclosures of de-identified information;
  • Disclosures relating to worker’s compensation programs;
  • Disclosures of a “limited data set” for research, public health, or health care operations;
  • Incidental disclosures that are an unavoidable by-product or permitted uses or disclosures;
  • Disclosures to “business associates” and their subcontractors who perform health care operations for us and who commit to respect the privacy of your health information in accordance with HIPAA; (Specify other uses and disclosures affected by state law).

Unless your object, we will also share relevant information about your care with any of you personal representatives who are helping you with your eye care. Upon your death, we may disclose to your family members or to other personals who were involved in your care or payment for health care prior to your death (such as your personal representative) health information relevant to their involvement in your care unless doing so is inconsistent with your preferences as expressed to us prior to your death.


The following are some specific uses and disclosures we may not make of your health information without your authorization:

Marketing activities. We must obtain your authorization prior to using of disclosing any of your health

information for marketing purposes unless such marketing communication take the form of face-to-face

communications we may make with individuals or promotional gifts of nominal value that we may provide. If such marketing involves financial payment to use from a third party, your authorization must also include consent to such payment.

Sale of health information. We do not currently sell or plan to sell your health information and we must seek your authorization prior to doing so.

Psychotherapy notes. Although we do not create or maintain psychotherapy notes on our patients, we are required to notify you that we generally must obtain your authorization prior to using or disclosing any such notes.


You have many rights concerning the confidentiality of your health information. You have the right:

  • To request restrictions on the health information we may use and disclose for treatment,

payment and health care operations. We are not required to agree to these requests. To request restrictions, please send a written request to use at the address below.

  • To receive confidential communications for health information about you in any manner other than described in our authorization request form. You must make such requests in writing to the address below. However, we reserve the right to determine if we will be able to continue your treatment under such restrictive authorizations.
  • To inspect or copy your health information. You must make such requests in writing to the address below. If you request a copy of your health information we may charge you a fee for the cost of copying, mailing or other supplies. In certain circumstances, we may deny your request to inspect or copy your health information, subject to applicable law.
  • To amend health information. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, you must write to us at the address below. You must also give us a reason to support your request. We may deny your request to amend your health information if it is not in writing or does not provide a reason to support your request. We may also deny your request if the health information:
    •  Was not created by us, unless the person that created the information is not longer available to make the amendment,
    • Is not part of the health information kept by or for us,
    • Is not part of the information you would be permitted to inspect or copy, or
    • Is inaccurate or incomplete.

  • To receive an accounting of disclosures of your health information. You must make such request in writing to the address below. Not all health information is subject to this request. Your request must state a time period for the information you would like to receive, no longer than 6 years prior to the date of your request and may not include dates before April 14, 2003. Your request must state how you would like to receive the report (paper, electronically).
  • To designate another party to receive your health information. If your request for access of your health information directs us to transmit a copy of the health information directly to another person, the request must be made by you in writing to the address below and must clearly identify the designated recipient and where to send the copy of the health information.

Contact Person:

Our contact person for all questions, requests, or for further information related to the privacy of your health information is:

Privacy Office OR Dept of Health and Human Services

(406) 449-3937 (406) 442-1837

1040 Partridge Pl Ste 10

Helena, MT 59602


If you think we have not properly respected the privacy of your health information, you are free to complain to us or to the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint the office contact person at the address, fax, or email shown above. If you prefer, you can discuss your complaint in person or by phone.

Changes to this Notice:

We reserve the right to change our privacy practices and to apply the revised practices to health information about you that we already have. Any revision to our privacy practices will be described in a revised Notice that will be posted prominently in our facility. Copies of this Notice are also available upon request at our reception area.

Insurance Practices for Quality Vision Care

As a courtesy, we will file insurance claims for our patients as long as we are supplied with the appropriate insurance information at time of service. 

  1. Vision Care Plans (such as VSP)
  2. Medical Insurance (such as BlueCross/BlueShield, Allegiance, Pacific Source, Medicare, Medicaid)
    • Vision care plans only cover routine vision exams and certain plans assist with eyeglasses and contact lenses. Vision plans only cover a basic screening for eye disease. They do not cover diagnosis, management, or treatment of eye diseases.
    • Medical insurance must be used if you have any eye health problems or systemic health problems that may affect your eyes. Your doctor will determine if these conditions apply to you, but some are determined by your health history.
    • If you have both types of insurance plans, it may be necessary for us to bill some services to one plan and other services to the other. We will use coordination of benefits to do this properly and to minimize your out-of-pocket expense.
    • We will bill your insurance plan for services if we are preferred providers for that plan. We would be glad to help you fill out any insurance forms that your plan may require if we are not preferred providers. We will try to obtain advanced authorization of your insurance benefits so we can tell you what is covered. If some fees are not paid by your plan, you are responsible for any unpaid deductibles, co-pays, or non-covered services as allowed by the insurance contract. (Example: Refraction ($40) or CL Eval ($55))
  • Due to insurance changes in January 2021, we are required to have 2 separate line items for billing. The exam and the refraction. Medical insurances do NOT cover the refraction and it will be your responsibility to pay at the time of exam. The cost for refraction is $40.

We accept all major forms of payments.