How We Collect Information About You |
Active Sports Therapy (AST) and its employees and volunteers collect data through a variety of means including but not necessarily limited to letters, phone calls, emails, voice mails, and from the submission of applications that are either required by law, or necessary to process applications or other requests for assistance through our organization.
What We Do Not Do With Your Information |
Information about your financial situation and medical conditions and care that you provide to us in writing, via email, on the phone (including information left on voice mails), contained in or attached to applications, or directly or indirectly given to us, is held in strictest confidence. We do not give out, exchange, barter, rent, sell, lend, or disseminate any information about applicants or clients who apply for or actually receive our services that is considered patient confidential, is restricted by law, or has been specifically restricted by a patient/client in a signed HIPAA consent form.
How We Do Use Your Information |
Information is only used as is reasonably necessary to process your application or to provide you with health or counseling services which may require communication between AST and health care providers, medical product or service providers, pharmacies, insurance companies, and other providers necessary to: verify your medical information is accurate; determine the type of medical supplies or any health care services you need including, but not limited to; or to obtain or purchase any type of medical supplies, devices, medications, insurance, etc.
If you apply or attempt to apply to receive assistance through us and provide information with the intent or purpose of fraud or that results in either an actual crime of fraud for any reason including willful or un-willful acts of negligence whether intended or not, or in any way demonstrates or indicates attempted fraud, your non-medical information can be given to legal authorities including police, investigators, courts, and/or attorneys or other legal professionals, as well as any other information as permitted by law.
Information We Do Not Collect |
We do not use cookies on our website to collect data from our site visitors. We do use some affiliate programs that may or may not capture traffic data through our site.
Limited Right to Use Non-Identifying Personal Information from Biographies, Letters, Notes, Videos and Other Sources |
Any pictures, stories, letters, biographies, correspondence, or thank you notes sent to us become the exclusive property of AST. Additionally, videos recorded in the office may be used for educational or case research purposes. We reserve the right to use non-identifying information about our clients (those who receive services or goods from or through us) for fundraising, promotional or educational purposes that are directly related to our mission. Clients will not be compensated for use of this information and no identifying information (addresses, phone numbers, contact information, last names or uniquely identifiable names) will be used without client’s express advance permission. You may specifically request that NO information be used whatsoever for promotional purposes, but you must identify any requested restrictions in writing. We respect your right to privacy and assure you no identifying information that you send to us will ever be publicly used without your direct or indirect consent.

When we do not have insurance information on file for an upcoming visit, we will provide you with a Good Faith Estimate of the cost of items and services that are reasonably expected for your health care needs and that is based on information known at the time it was created. If you are billed for more than the Good Faith Estimate amount, you have the right to dispute the bill.

You may contact the health care provider or facility listed to let them know that the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.
You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date of the original bill.
There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on the Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 1-877-696-6775. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 1-877-696-6775.
Keep copies of any Good Faith Estimates you receive in a safe place or take pictures of them. You may need them if you are billed a higher amount.

Insurance Verification |
Insurance verification is not a guarantee of payment. Verification is only a quote of patient benefits. As a courtesy we provide an estimate based on the current fee schedule for your insurance carrier. This estimate may be slightly lower or higher than your actual incurred charges due to misinformation, case complications or additional or less therapies needed. Insurance companies review charges individually and make payment accordingly. Charges not covered by insurance are the patient’s responsibility and due within 30 days of billing. We recommend each patient verify chiropractic benefits by referring to the plan summary provided by the insurance company or by calling the customer service phone number located at the bottom or back of your insurance card.
Deductible Payments |
It is our policy to collect at time of service. Once we receive an “Explanation of Benefits” report form the patient’s insurance company, we will bill or credit the account for the remaining balance. Reimbursement checks can be issued upon request.
Collection of Patient Balance |
Co-payments and Co-insurance is the patient’s responsibility and will be collected at the time of service. If an “Explanation of Benefits” or EOB shows the patient has an outstanding responsibility for any reason, the patient will receive a bill outlining the outstanding charges. Payment is due within 30 days of receipt of the bill. In the event a bill is disputed, you must notify us within 30 days. If you do not notify us within that time, the bill will be presumed valid and due. All balances remaining unpaid after 30 days will accrue interest at the rate of 18% per annum. In the event any further action is necessary to collect an unpaid bill, you will be responsible for all attorney’s fees, court costs or collection fees incurred by us. All balances remaining unpaid after 30 days may be reported to a credit bureau and affect your credit rating.
Returned Checks |
It is our policy to collect $25.00 for checks that are returned to us. This is to cover any fees that apply from the transaction.
Appointments |
If unable to keep an appointment, as a courtesy to our staff and other patients please give 24-hour notice. If it is a continual problem there will be a $20 charge added towards your account each visit that is missed. The patient will be responsible for payment. For Workmen’s Compensation and Personal Injury patients, documentation of any missed appointments is forwarded to your case manager and primary physician. This may jeopardize your claim.
Financial Policy Questions |
We are happy to address questions regarding your account at any time. Please direct accounting questions to our billing administrator, Cassie Hulme by contacting the office at 615-537-5520 or by e-mail at Cassie@activesports.care