General Policies
- Locations we service: Although we service the Indianapolis area and are available to travel to any Indiana address, when and where we schedule appointments is completely up to the discretion of Dr. Kroft.
- Appointment verification: We verify every appointment by text message unless an alternative contact method is requested. If we do not receive a response prior to your appointment, we will consider the appointment canceled and a cancellation fee of $50.00 will be charged.
- Be prepared and on time: We will be prepared and on time for your appointment and ask the same of you. You have a dedicated time slot for your appointment that starts at your scheduled appointment time and ends 30 minutes from that time regardless of when treatment commences. We ask that you wear comfortable, relaxed-fitting clothes during your appointment.
- Canceled or missed appointments: Please give 24 hr or "day before" notice for an appointment that needs to be canceled or rescheduled. If appropriate notice is not given, you will be charged a $50.00 cancellation fee.
- Right of refusal: We reserve the right to refuse service to anyone at any time for any reason.
Financial Policies
- Fees: We charge a $80 fee per initial session per patient. Fees for additional visits will be determined by Dr. Kroft depending on severity of patient case and distance traveled to destination. Corporate account fees differ from residential and are prorated at $200/hour. By clicking "I agree" at the end of the New Patient form, you are agreeing to the fees as listed unless part of a corporate form in which the employer or manager agrees the the fees.
- Payment methods: All payments are due prior to, or at the time of your appointment. Payments can be made by cash, local check, credit card or emailed invoice. Checks not honored by your bank will be subject to an additional $30 fee.
- Health insurance: We DO NOT accept health insurance and do not assist with any attempt at reimbursement for our services.
- Refunds: Completed appointments are not refundable.
- Receipts: Receipts are available by email when requested.
- Additional fees: Additional fees may apply for appointments outside of our normal service area or normal hours. However, we are 100% transparent with our fees and you will never be charged an additional fee without discussing and agreeing to these fees with Dr. Kroft.
Privacy Policies
Our privacy policies can be found here on our website. You can also request a copy of privacy policies which will be send by email only.
Informed Consent For Treatment
I understand that I am responsible for full payment of all services rendered by Kroft Chiropractic, LLC. I have read and understand the preceding statements and hereby consent to myself (or those I claim as dependent) voluntarily participating in chiropractic care and/or physiotherapeutic rehabilitation procedures as deemed appropriate by my doctor. If at any time I decide that I am unwilling to engage in these procedures, I reserve the right to inform my doctor of such and not participate in evaluation or treatment. I understand that results are not guaranteed and that I have the opportunity to discuss the purposes and risks associated with all recommended evaluation and treatment procedures at any time.
HIPAA Privacy Act
The HIPAA privacy rule permits us to communicate with you regarding your health care. We will notify you by phone if we have to change, alter or cancel your schedule appointment. Appointments are considered part of your treatment. Authorization or permission to call is not required. HIPAA allows a message to be left on an answering machine, voicemail, text message or with a third party. Information will be limited to no more than necessary.
You have the right refuse to give us authorization to contact you to provide appointment reminders, information about treatment alternatives, or to other health related information. If you do not give us authorization, it will not affect the treatment we provide to you or the methods we use to obtain reimbursement for your care.
You may inspect or copy the information that we use to contact you to provide appointment reminders, information about treatment alternatives, or other health related information at any time.
Patient’s Bill of Rights
These rights can be exercised on the patient’s behalf by a designated surrogate or proxy decision-maker if the patient lacks decision-making capacity, is legally incompetent, or is a minor.
The patient has the right to considerate and respectful care.
The patient has the right to and is encouraged to obtain from physician and other direct caregivers relevant, current and understandable information concerning diagnosis, treatment and prognosis.
Patients have the right to make the identity of physicians, nurses, and residents, interns or other trainees. The patient also had the right to know the immediate and long term financial implications of treatment choices, insofar as they are known.
The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and clinic policy and to be informed of the medical consequences of this action. In case of such refusal, the patient is entitled to their appropriate care and services that the clinic provides or transfer to another health care provider. The clinic should notify patients of any policy that might affect patient choice within the institution.
The patient has the right to have an advance directive (such as a living will, health care proxy, or durable power of attorney for health care) concerning treatment or designating a surrogate decision maker with the expectation that the clinic will honor the intent of that directive to the extent permitted by law.
The patient has the right to every consideration of privacy. Case discussion, consultation, examination and treatment should be conducted so as to protect each patient’s privacy.
The patient has the right to expect that all communications and records pertaining to his/her care will be treated as confidential by the clinic, except in cases such as suspected abuse and public health hazards when reporting is permitted or required by law. The patient has the right to expect that the clinic will emphasize the confidentiality of this information when it releases it to any other parties entitled to review information in those records.
The patient has the right to review the records pertaining to his/her medical care and to have the information explained or interpreted as necessary, except when restricted by law.
Notice of Privacy Practices for Protected Health Information
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Uses and Disclosures
Here are some examples of how we are allowed to disclose your private health care information for treatment, payment or clinic operations.
- Your health care provider or a staff member may disclose your health care information including all of your clinical records to another health care provider or a hospital if it is necessary to refer you to them for diagnosis, assessment, or treatment of your health condition.
- Your health care provider and members of the practice staff may use your health information, examination and treatment records and your billing records for quality control purposes or for other administrative purposes to efficiently and effectively run our practice.
- Your health care provider and member s of the practice staff may use your name, address telephone number, and your clinical records to contact you to provide appointment reminders, information about treatment alternatives, or other health related information that may be of interest to you. 164.250 (b)(1)(iii)(A). If you are unable to receive an appointment reminder, a text or voicemail message will be left on your phone.
The HIPAA privacy rule permits us to communicate with you regarding your health care. We will notify you by phone if we have to change, alter or cancel your schedule appointment. Appointments are considered part of your treatment. Authorization or permission to call is not required. HIPAA allows a message to be left on an answering machine, voicemail, text message or with a third party. Information will be limited to no more than necessary.
You have the right refuse to give us authorization to contact you to provide appointment reminders, information about treatment alternatives, or to other health related information. If you do not give us authorization, it will not affect the treatment we provide to you or the methods we use to obtain reimbursement for your care.
You may inspect or copy the information that we use to contact you to provide appointment reminders, information about treatment alternatives, or other health related information at any time.
Permitted uses and disclosures without your consent or authorization
Under federal law, we are also permitted or required to use or disclose your health information without your consent or authorization in these following circumstances:
- We are permitted to use or disclose your health information if we are providing health care services to you based on the orders of another health care provider.
- We are permitted to use or disclose your health information if we provide health care services to you as an inmate.
- We are permitted to use or disclose your health information if we provide health care services to you in an emergency.
- We are permitted to use or disclose your health information if we are required by law to treat you and we are unable to obtain your consent after attempting to do so.
- We are permitted to use or disclose your health information if there are substantial barriers to communicating with your, but in or professional judgment we believe that you intend for us to provide care to you.
Other than the circumstances described in the preceding five examples, and the section Uses and Disclosures of this document, any other uses or disclosure of your health information will only be made with your written authorization.
Your right to revoke your authorization
You many revoke your authorization to us at any time; however, your revocation must be in writing and mailed to our office. We will not be able to honor your revocation request if we have already released your health information before we received your request to revoke your authorization. 164.508(b)(5)(i)
If you wish to revoke your authorization, please write to us at:
Kroft Chiropractic, LLC
PO Box 11263
Indianapolis, IN 46201
Your right to limit uses or disclosures
If there are health care providers, hospitals employers, insurers, or other individuals or organizations to whom you do not want us to disclose your health information, please let us know, in writing, what individuals or organizations to whom you do not want us to disclose your health care information. We are not required to agree to your restrictions. However, if we agree with your restrictions, the restrictions are binding on us. If we do not agree to your restrictions, you may drop your request or you are free to seek care from another health care provider.
Your right to receive confidential communication regarding your health information
We normally provide information about your health information to you in person at the time you receive services from us. We may also mail you information regarding your health or about the status of your account. We will do our best to accommodate any reasonable request if you would like to receive information about your health or the services that we provide at a place other than your home or, if you would like information in a different form. To help us respond to your needs, please make any requests in writing.
Your right to inspect and copy your health information
You have the right to inspect and/or copy your health care information for seven years from the date that the record was created or as long as the information remains in our files. We require your request to inspect and/or copy your health information to be in writing.
Your right to amend your health information
You have the right to request that we amend your health information of seven years from the date that the record was created or as long as the information remains in our files. We require your request to amend your records to be in writing and for you to give us a reason to support the change you are requesting us to make.
Your right to receive an accounting of the disclosures we have made of your records
You have the right to request that we give you an account of the disclosure we have made of your health information for the last six years before the date of your request. The accounting will include all disclosures except:
- Those disclosures required for your treatment, to obtain payment for your services, or to run our practice.
- Those disclosures made to you.
- Those disclosures necessary to maintain a directory of the individuals in our facility or to individuals involved in your care.
- Those disclosures for national security or intelligence purposes.
- Those disclosures made to correctional officers or law enforcement officers.
- Those disclosures that were made prior to the effective date of the HIPAA privacy law.
We will provide you the first accounting within any 12-month period without charge. There is a fee for any additional requests during the next 12 months. When you make your request we will tell you the amount of the fee and you will have the opportunity to withdraw or modify your request.
Your right to a paper copy of this notice
If you have agreed to receive privacy notices by email, you may request a paper copy of this notice at any time.
Our duties
We are required by law to maintain the privacy of your health information. We are also required to provide you with this notice of our legal duties and our privacy practices with respect to your health information.
We must abide by the terms of this notice while it is in effect. However, we reserve the right to change the terms of our privacy notices. If we make a change to the terms of our privacy agreement, we will notify you in writing when you come in for treatment or by mail. If we make a change in our privacy terms, the change will apply for all of your health information in our files.
Re-disclosure
Information that we use or disclose may be subject to re-disclosure by the person to whom we provide the information and may no longer be protected by the federal privacy rules.
Your right to complain
You may complain to us or to the Secretary for Health and Human Services if you feel that we have violated your privacy rights. We respect your right to file a complaint and will not take any action against you if you file a complaint. While you may make an oral complaint at any time, written comments should be addressed to us at:
Kroft Chiropractic, LLC
PO 11263
Indianapolis, IN 46201
Marketing
From time to time our practice works with marketing organizations to make you aware of products or services that you may have an interest in purchasing. We may need to use your health information including your home, address, telephone number, and your clinical records for the purpose of marketing products or services to you. The authorization form you sign for this purpose contains the name of the organization and/or the products and services we are marketing.
You have the right to refuse to give us authorization to contact you for marketing purposes. If you do not give us authorization, it will not affect the treatment we provide to you or the methods we use to obtain reimbursement for your care.
You may inspect or copy the information that we use to market products and/or services to you at any time. Our practice and staff will receive direct or indirect remuneration from our marketing activities.
Our privacy pledge
We have and always will respect your privacy. Other than the uses and disclosures we described above, we will not sell or provide any of your health information to any outside organizations. If you would like to further information about our privacy policies and practices, please contact:
Kroft Chiropractic, LLC
PO 11263
Indianapolis, IN 46201