Pulmonary & Critical Care Associates, P.C.

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request that the denial be reviewed. Another licensed health care professional chosen by the practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

Amend: If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the practice. Any request for an amendment must be sent in writing to the Privacy Officer at this practice. In addition, you must provide a reason that supports your request. 

We may deny your request for an amendment and if this occurs, you will be notified of the reason for the denial. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Statements of disagreement and any corresponding rebuttals will be kept on file and sent out with any future authorized requests for information pertaining to the appropriate portion of your record.

An Accounting of Disclosures: You have the right to request an accounting (which means a detailed listing) of disclosures. This is a list of certain disclosures we make of your health information for purposes other than treatment, payment or health care operations where an authorization was not required. If you request an accounting more than once every 12 months, we may charge you a fee to cover the costs of preparing the accounting.

Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. Example: You could ask that we not use or disclose information about a surgery you had. Any request for a restriction must be sent in writing to the practice’s Privacy Officer.

• We are required to agree to your request only if 1) except as otherwise required by law, the disclosure is to your health plan and the purpose is related to payment or health care operations (and not treatment purposes), and 2) your information pertains solely to health care services for which you have paid in full. For other requests, we are not required to agree. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
• You also have the right to request that we restrict disclosures of your medical information and healthcare treatment(s) to a health pan (health insurer) or other party, when that information relates solely to a healthcare item or service for which you, or another person on your behalf (other than a health plan), has paid us for in full. Once you have requested such restriction(s), and your payment has in full has been received, we must follow your restriction(s).

Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. Example: You may ask that we contact you at work instead of your home. The practice will grant reasonable requests for confidential communications at alternative locations and/or via alternative means only if the request is submitted in writing to the practice’s Privacy Officer and the written request includes a mailing address where the individual will receive bills for services rendered by the practice and related correspondence regarding payment for services. Please realize, we reserve the right to contact you by other means and at other locations if you fail to respond to any communication from us that requires a response. We will notify you in accordance with your original request prior to attempting to contact you by other means or at another location. We reserve the right to deny a request if it imposes an unreasonable burden on the practice.

Right to Opt-Out of Fundraising Communications: If we conduct fundraising and we use communications like the U.S. Postal Service or electronic mail for fundraising, you have the right to opt-out of receiving such communications from us.

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We have
4 locations throughout southeast lower Michigan

Shelby Township
50505 Schoenherr Road

Suite 290
Shelby Twp., MI 48315
Phone: 586-314-0080
Fax: 586-731-6253
     >>  Map  << 

St. Clair Shores
25319 Little Mack
St. Clair Shores, MI 48081
Phone: 586-772-5550
Fax: 586-772-1706
>>  Map  <<

Sterling Heights
44344 Dequindre
Suite 410
Sterling Heights, MI 48314
Phone: 586-262-5100
Fax: 586-262-5096
      >> Map <<

25689 Kelly Road
Suite 100
Roseville, MI 48066
Phone: 586-445-5995
Fax: 586-445-5977
 >> Map <<