Patient Bill of Rights and Responsibilities
At Christie Clinic, we seek to provide quality care that is fair, responsive and accountable to the needs of each patient and family. We are committed to ensuring that each patient is treated with respect and as an equal partner in care. You can help us make your healthcare experience safe by being an active and informed partner with your healthcare team.
As our patient, we want to make sure you understand your rights and responsibilities.
As a patient, you have the right to...
• Receive considerate, respectful and compassionate health care regardless of your age, gender, race, national origin, religion, sexual orientation, gender identity or disability or any other status protected by relevant law.
• Expect courteous and helpful attention and understanding from Clinic employees.
• Obtain complete and current information regarding our knowledge of your health status, your diagnosis, treatment and prognosis.
• Make decisions about your care. You or your legally designated representative should expect to receive information needed to give informed consent, including proposed procedures and treatment options and their risks and benefits. You have the right to refuse treatment to the extent permitted by law, and to be informed of the medical consequences of this action.
• Receive prompt treatment in emergency situations, regardless of economic status.
• Have privacy and confidentiality. Communications and records pertaining to your care will be treated in confidence.
• Know what Clinic rules apply to your conduct as a patient.
• Prepare advanced directives and receive care that meets your wishes as permitted by law.
• Ask questions or voice concerns about care or service by talking with a staff member, including management staff and/or a patient liaison at 217.366.8034.
To help us provide you with quality care, you are responsible for:
• Providing, to the best of your knowledge, complete and accurate medical information, including the nature of your illnesses, medications, hospitalizations, and family history of illness, advance directives, and other matters relating to present health.
• Asking questions if you do not understand your treatment plan and making informed decisions about your care.
• Following Clinic rules as they affect patient care and cooperating with Clinic staff.
• Following medical advice and instructions given for healthcare services, and to inform your provider if you have chosen not to follow that advice.
• Providing complete, accurate and timely information about insurance or other sources of payment for the care provided and your ability to pay for services rendered.
• Fulfilling your financial obligations for your healthcare as arranged and as promptly as possible.
• Keeping scheduled appointments or canceling them at least 48 hours in advance.
As our patient, you are responsible for confirming benefits with your insurance plan prior to receiving healthcare services.
Christie Clinic does not accept responsibility for collection of insurance benefits or negotiation of the settlement of a disputed claim. As our patient, you are responsible for payment of all Clinic charges regardless of anticipated insurance coverage. Christie Clinic does not accept “Usual and Customary” of lower fee determinations from insurance companies.
By signing the signature card, you agree to pay all costs of collection, including reasonable attorneys’ fees, which may be incurred in the collection of any and all indebtedness due by you to Christie Clinic.
Patient Billing Information
Your responsibilities as a patient:
To process insurance claims on your behalf, you must provide us with accurate, up-to-date insurance information for you at the time of your visit. Your insurance information is usually located on the insurance card sent to you when you enrolled in the plan. Bring this card each time you come to the Clinic.
Because each insurance plan can be unique, you are responsible for understanding the benefits and obligations of your health insurance. Please review your plan’s literature or talk with your insurance representative if you have specific questions related to your coverage, deductibles or co-payments.
Co-payments for your visits are due on the day you are seen by the healthcare provider.
Payments for certain medical services may be due on the day of your visit. These amounts will be discussed with you at the Clinic or by phone prior to your visit by a Patient Account Specialist.
If it is necessary to cancel your scheduled appointment, we require that you call at least 48 hours in advance of your appointment. Patients who fail to cancel their appointments in a timely manner may be subject to a cancellation fee. Patients who repeatedly fail to keep appointments are subject to discontinuation from the practice.
To ensure timely communication of test results and other information from the Clinic, you must provide us with your current demographic information, including address and phone number. If you provide us with a wireless/cell phone number, you grant us your consent to receive calls at that number.
Our responsibilities to you as a patient:
We will submit a claim on your behalf to your insurance company after your visit.
We will provide each patient with an outstanding balance, a monthly statement that details the activity (charges and payments). Any patient responsibility balance on that statement is due within 30 days of the statement.
The following methods of payments are available to our patients.
• Cash, Check or Money Order
• Debit Card
• Visa, Mastercard, Discover
• Electronic checking withdrawal
A patient who does not have health insurance will be expected to pay a minimum amount set by the Clinic towards that day’s services. Patient Account Specialists are available to assist you at the time of your visit.
Financial counseling is available for patients either in person at the Clinic or by calling 217.366.1382.
Health information exchange. We may share information that we obtain or create about you with other health care providers or other health care entities, such as your health plan or health insurer, as permitted by law, through health information exchanges (HIE). For example, information about your past medical care and current medical conditions and medications can be available to us, other care providers or a hospital, if they participate in the HIE as well. Exchange of health information can provide faster access, better coordination of care and assist providers and public health officials in making more informed decisions. Health records will be available to the HIE unless an individual elects to opt-out. An individual who wishes to opt-out of participation in the HIE should contact the Health Information Services Department to request this restriction. An individual’s decision to opt-out of HIE participation will not adversely affect his or her ability to receive care. However, it may affect the information available to the provider. It does not affect the sharing of health information for treatment through more traditional methods, such as having records faxed or mailed. After choosing to opt-out of HIE participation, an individual may later decide to opt back in by contacting the Health Information Services Department.
Your Statement of Account
Services not covered by insurance due to annual deductible, co-payment, co-insurance, non-covered services, usual and customary or termination of benefits are the responsibility of the patient.
Your monthly Statement of Account will reflect the patient responsibility portion of the charges assessed to your account during the prior billing cycle. Payment is due on those monthly charges within 30 days from the “Statement Date.” The “Statement Date” appears near the top right-hand corner of your Statement of Account. The bottom center portion of your Statement of Account shows your aging balances from prior Statements of Account.
The Clinic reserves the right to impose a FINANCE CHARGE on any balance of a Statement of Account remaining unpaid for 90 days or more. This is figured by taking the balance you owe on your last Statement of Account and subtracting any unpaid FINANCE CHARGE, and any Payments and credits received within the first 27 days of the present billing cycle. Any portion of that balance remaining which is still 90 days past due will be subject to a FINANCE CHARGE. Payments received by us within 90 days of when you were first billed for services will have been credited to your account and a FINANCE CHARGE will not accrue on those amounts so paid.
Any FINANCE CHARGE on balances over 90 days past due will be calculated at a periodic rate of 1 ½% per month (which is at an ANNUAL PERCENTAGE RATE OF 18%) or a flat rate of $.50 per month, whichever is greater.
Christie Clinic does not issue refunds on accounts with outstanding claims or balances; with upcoming scheduled services with any Christie Clinic provider; or for credit balances less than the price of a postage stamp and reasonable processing costs.
Your Billing Rights
If you think your bill is wrong or if you need more information about a transaction on your bill, write to us as soon as possible and no later than 60 days after we sent you the first Statement of Account on which the error or problem appeared, at the following address:
Customer Service Department
101 W. University Avenue
Champaign, IL 61820
You may also call us, but doing so does not preserve your rights.
In your letter, you must provide us the following information:
• Your name and account number
• Dollar amount of the suspected error
• Describe the error and explain, if you can, why you believe there is an error. If you need more information, describe the item you are not sure about.
Your Rights and Our Responsibilities After We Receive Your Written Notice
We will acknowledge your letter within 30 days, unless we have corrected the error prior to that time. Within 90 days, we will either correct the error or explain why we believe the Statement of Account is correct.
After we receive your letter, we will not try to collect any amount you question, or report you as delinquent while we are investigating and prior to making appropriate corrections or explaining why we believe the Statement of Account is correct. We can continue to bill you for the amount you question, including any FINANCE CHARGE. You do not have to pay the parts of your Statement of Account that are in question, but you are obligated to pay the parts of the Statement of Account that are not in question.
If we find that we made a mistake on your Statement of Account, you will not have to pay FINANCE CHARGES RELATED TO ANY QUESTIONED AMOUNT. If your Statement of Account was correct, the Clinic reserves the right to impose FINANCE CHARGES for which you are responsible, and you will have to make up missed payments on the questioned amount. In either case, we will send you a statement of the amount you owe and the date that it is due.
If you fail to pay the amount that we think you owe, we may report you as delinquent. However, if our explanation does not satisfy you and you write to us within 10 days, telling us that you still refuse to pay, we must tell anyone we report you to that you have a question on your bill. We must also tell you the name of anyone we reported you to. We must tell anyone we report you to, that the matter has been settled between us when it is resolved.
Notice About Nondiscrimination and Accessibility Requirements
Christie Clinic complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Christie Clinic does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Christie Clinic provides the following aids and services free of charge:
- Aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats, other formats);
- Language services to people whose primary language is not English, such as qualified interpreters and information written in other languages
If you need these services, contact Christie Clinic’s Section 1557 Coordinator.
If you believe that Christie Clinic has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Section 1557 Coordinator, 101 W. University Ave., Champaign, IL 61820, 217-366-1200, 217-366-1294, email@example.com. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Section 1557 Coordinator is available to help you.
Christie Clinic complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1–217-366-1200 (TTY: 1–888-391-0412).
ATENCIÓN:si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.Llame al 1–217-366-1200 (TTY: 1–888-391-0412).
UWAGA:Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej.Zadzwoń pod numer 1–217-366-1200 (TTY: 1–888-391-0412).
注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1–217-366-1200 (TTY: 1–888-391-0412).。
주의:한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.1-217-366-1200 (TTY: 1–888-391-0412) 번으로 전화해 주십시오.
PAUNAWA:Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.Tumawag sa 1-217-366-1200 (TTY: 1–888-391-0412)
ملحوظة:إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان.اتصل برقم 1-217-366-1200 (رقم هاتف الصم والبكم: 1-888-391-0412).
ВНИМАНИЕ:Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.Звоните 1–217-366-1200 (телетайп: 1–888-391-0412).
સુચના: જો તમે ગુજરાતી બોલતા હો, તો નિ:શુલ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો 1–217-366-1200 (TTY: 1–888-391-0412).
خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال کریں 1-217-366-1200 (TTY: 1-888-391-0412).
CHÚ Ý:Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.Gọi số 1–217-366-1200 (TTY: 1–888-391-0412).
ATTENZIONE:In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti.Chiamare il numero 1–217-366-1200 (TTY: 1–888-391-0412).
ध्यान दें:यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। 1–217-366-1200 (TTY: 1–888-391-0412) पर कॉल करें।
ATTENTION :Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.Appelez le 1–217-366-1200 (ATS : 1–888-391-0412).
ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε 1–217-366-1200 (TTY: 1–888-391-0412).
ACHTUNG:Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.Rufnummer: 1–217-366-1200 (TTY: 1–888-391-0412).