8895 Broadway
Merrillville, IN 46410
219-736-4660 ext. 136

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Patient Rights and Responsibilities

Every patient has the right to be treated as an individual with his/her rights respected. Your patient rights are as follows:

  1. To receive treatment without discrimination as to race, color, religion, sex, national origin, disability, or source of payment.
  2. To receive considerate and respectful care in a clean and safe environment free of unnecessary restraints.
  3. To understand the indications for the procedure.
  4. To receive all the information you need to give informed consent for any procedure including the possible risks and benefits of the procedure.
  5. To receive complete information about your diagnosis, planned treatment, and prognosis. When it is medically inadvisable to give such information to you, the information will be provided to a person designated by you or to a legally authorized person.
  6. To participate in all decisions involving health care, except when such participation is contra-indicated for medical reasons.
  7. To receive assessment and management of pain.
  8. To privacy, confidentiality, and integrity of all information and records regarding your care.
  9. To approve or refuse the release of your medical records except when required by law.
  10. To be aware of fees for service and the billing process.
  11. To refuse treatment and be told what effect this may have on your health.
  12. To complain without fear of reprisals about the care and service you are receiving.
  13. To be assured safe use of equipment by trained personnel.
  14. To refuse to participate in experimental research.
  15. To change physicians if you choose to do so, if other qualified physicians are available.

Patient Conduct and Responsibility

  1. To provide the healthcare providers with information about any past illnesses, hospitalizations, medications and other health matters.
  2. To inform the healthcare provider of any Living Will/Advanced Directives and provide a copy.
  3. To ask questions if you do not understand instructions or explanations given by the healthcare providers and/or staff.
  4. To keep appointments as scheduled and to telephone the Endoscopy staff in case of a cancellation.
  5. To follow healthcare providers instructions and plan of treatment.
  6. To provide a responsible adult to drive you to and from the Endoscopy center for a sedated procedure.
  7. To provide a 24 hour caregiver to stay with you after a procedure, if it is necessary.
  8. To make payments for service rendered if a balance remains after insurance pays.
  9. To discuss consequences of refusing treatment or not adhering to plan of treatment or leaving “against medical advice” (AMA), with your physician.
  10. To refuse to participate in experimental research.
  11. To refuse to allow care from a student or trainee.

We appreciate you choosing our Endoscopy Center for your procedure. This information should help eliminate some of your billing questions.
Beginning in January 2011, IMA Endoscopy SurgiCenter started to use Nurse Anesthetists to administer propofol (deep) sedation. You will also receive a bill for their services.
You will receive two statements after your visit here – one from Internal Medicine Associates for the physician fee and on from IMA Endoscopy SurgiCenter fr the facility (hospital) fee. In addition, if biopsies are taken during the procedure, you will receive a third statement from the pathology service. (OncoDiagnostics or Methodist Hospital Pathologists)
All charges will be submitted to your insurance company. All of our physicians accept Medicare assignment. If you have any questions, please contact our billing service, Medoptima, at 1-866-261-6259.
You are responsible for any balance remaining after the insurance company has paid.