top of page

Privacy Policy and Benefits Assignment

Wildflower Telehealth, Inc.

Privacy Policy

  1. Introduction

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. BY ACCESSING THE SITE, DOWNLOADING THE MOBILE APPLICATION AND/OR USING THE SERVICES, YOU AGREE TO THE PRACTICES AND POLICIES OUTLINED IN THIS PRIVACY POLICY AND YOU HEREBY CONSENT TO THE COLLECTION, USE, AND SHARING OF YOUR INFORMATION AS DESCRIBED IN THIS PRIVACY POLICY.  IF YOU DO NOT AGREE WITH THIS PRIVACY POLICY, YOU CANNOT USE THE SERVICES. THIS POLICY MAY CHANGE FROM TIME TO TIME. YOUR CONTINUED USE OF THE SERVICES AFTER WE REVISE THIS POLICY MEANS YOU ACCEPT THOSE CHANGES, SO PLEASE CHECK THE POLICY PERIODICALLY FOR UPDATES.

 

Wildflower Telehealth Network, Inc. (us, we, or “Wildflower Telehealth”) is committed to maintaining the privacy and confidentiality of your health information. We will only use or disclose (share) your health information as described in this Notice.

 

  1. Using and Sharing your Information. This section describes the different ways that we may use and share your information. We will usually contact you for these purposes by phone, but if you have given us your email address or permission to send a text message, we may contact you that way. Communication by text message and email may be unsecure and unencrypted, and by providing us your mobile phone number or email, you authorize Wildflower Telehealth to communicate with you in this way. We mainly use and share your information for treatment, payment, and health care operation purposes. This means we use and share your health information:

  • with other health care providers who are treating you or with a pharmacy that is filling your prescription.

  • with your insurance plan to collect payment for health care services or to get preapproval for your treatment; and

  • to run our business, improve your care, educate our professionals, and evaluate provider performance.

 

Sometimes we may share information with our business associates such as a billing service, who help us with our business operations. All of our business associates must protect the privacy and security of your health information just as we do.

 

We are also allowed, and sometimes required by law, to share your information in other ways.

We have to meet certain conditions in the law before we can share your information for the following reasons. Some examples of each include:

  • Public health and safety: reporting diseases, births, or deaths; reporting suspected abuse, neglect, or domestic violence; to avoid a serious threat to health or public safety; monitoring product recalls; and reporting information for safety and quality purposes.  

  • Judicial and administrative proceedings: responding to a court or administrative order.

  • Workers’ compensation and other government requests: workers’ compensation claims payment or hearings; health oversight agencies for activities authorized by law; special government functions (military, national security)

  • Law enforcement: with a law enforcement official to identify or find a suspect or missing person.

  • Comply with the law: to the Department of Health and Human Services to see if we are complying with federal privacy law.

  • Disaster relief situation: sharing your location and general location for the purpose of notifying your family, friends, and agencies chartered by law to assist in emergency situations.

 

 

In the following situations, we will only use or share your information if you give us permission:

  • For marketing purposes

  • Sale of your information or payments from a third party

  • Any other reasons not describe in this Notice

 

You can revoke (take back) that permission, except when we have already relied on it, by contacting the Privacy Officer.

 

  1. Your Rights. When it comes to your health information, you have certain rights. You may:

  • Review or get an electronic or paper copy of your medical record, including billing records. You may be charged a reasonable cost-based fee for your records. We will let you know about any delay.

  • Request confidential communications. You can ask us to contact you in a certain way, for example, by cell phone. We will say "yes" to all reasonable requests.

  • Ask us to limit what we use or share for your treatment, payment, and healthcare operations. We are not required to agree to your request, but we will review it. When you pay for services out-of-pocket, in full, and ask us not to share the information with your insurance plan, we will agree unless a law requires us to share that information.

  • Ask us to correct your medical record if it is inaccurate or incomplete. We may say "no" to your request, but we will tell you why in writing within 60 days.

  • Get a list of those with whom we have shared information. You can ask for a list (accounting) of the times we shared your information and why for the six years prior to your request. Not all disclosures will be included in this list, such as those made for treatment, payment, or health care operations. You have the right to get this list one time every 12 months without charge, but we may charge you for the cost of providing additional lists during that time.

  • Get a copy of this privacy Notice. Just ask us and we will give you a copy in the format you would like (paper or electronic).

  • Choose someone to act for you. This "personal representative" can exercise your rights and make choices about your health information. Generally, parents and guardians of minors will have this right for the child, unless the minor is permitted by law to act on their own behalf.

  • File a complaint if you feel your rights have been violated. You may contact the Privacy Officer or the Secretary of the United States Department of Health and Human Services. We will not retaliate or take action against you for filing a complaint.

  • Request additional privacy protections with respect to your electronic medical record.

 

  1. Our Responsibilities.

  • We are required by law to maintain the privacy of your protected health information.

  • We will notify you if a breach occurs that may have compromised the privacy or security of your identifiable information.

  • We must follow the practices described in this Notice and give you a copy of it.

  • We reserve the right to change the terms of this Notice and the changes will apply to all information we have about you. The new Notice will be available upon request and on our website at www.wildflowerhealth.com

 

 

  1. Contact Information

Wildflower Telehealth welcomes your questions or comments regarding this Privacy Policy.  If you believe that Wildflower Telehealth has not adhered to this Privacy Policy, please contact Wildflower Telehealth at support@wildflowertelehealth.com. We will use commercially reasonable efforts to promptly respond and resolve any issue or question.

​

This policy was last updated on March 2024.

DESIGNATION OF AUTHORIZED REPRESENTATIVE / ASSIGNMENT OF BENEFITS

  I hereby appoint Wildflower Telehealth Network Inc. (“Provider”) as my Authorized Representative. I irrevocably assign and transfer to Provider all rights to receive any health plan proceeds and benefits that may be due to me and my baby under any health plan, liability insurance policy, and/or billing agent (collectively referred to as “Health Plan”) under which I and my baby are covered, for lactation support, counseling, and breastfeeding services (collectively “Services”) provided by the Provider.

 

I authorize Provider to submit all claims for Services on behalf of myself and my baby and direct my Health Plan to pay Provider directly any payment/ benefits due to me and my baby for any and all claims for Services rendered. I designate Provider as my and my baby’s representative in any discussions needed to secure payment or benefits from the Health Plan. Additionally, this Designation of Representative and Assignment of Benefits serves, without limitation, to authorize Providers to:         

 

  • Exercise all rights and remedies on our behalf under the Health Plan and applicable laws, including administrative, legal, and equitable actions;

  • Communicate with my and my and baby’s Health Plan and its affiliates; and

  • For purposes of Provider’s own treatment, payment, or health care operations, Provider may request and obtain any and all of my and my baby’s files, documents, correspondence including, but not limited to:

    • Any and all payment and benefit information;

    • Any and all appeal information;

    • medical and clinical records; and

    • any and all plan documents, policies, and any and all Health Plan information.

 

To achieve the purposes outlined above, I grant Provider the authority to take all necessary actions to facilitate these objectives.

 

I grant Provider the full authority to appeal any denials, underpayments, or misclassifications of claims, as well as to address any recoupment or offset of claim payments for Services. This includes the right to file disputes in any suitable forum against my and my baby’s Health Plan for claims related to Services provided by Provider. This assignment encompasses the right to pursue all legal, equitable, and administrative remedies under applicable state and federal laws and regulations.

 

CONSENT TO BILL AND ACKNOWLEDGEMENT OF WILDFLOWER TELEHEALTH NETWORK’S SERVICES AND POLICIES

 

I acknowledge that insurance billing for lactation consultations includes services provided to both the parent and the baby. I understand that the Lactation Consultant, as a health care provider, is responsible for evaluating and recommending a care plan to address breastfeeding issues. A lactation visit involves a detailed history of both mother and infant, an assessment of their anatomy, observation of a feeding session to evaluate technique and effectiveness, and recommendations for managing and resolving breastfeeding-related issues. I recognize that solving a breastfeeding problem may take several days or weeks and might require adjustments to the initial care plan. I confirm that I have actively participated in a care plan with Wildflower Telehealth Network, Inc. for both myself and my baby(s).

I HAVE READ AND UNDERSTAND THE ABOVE AND AGREE TO DESIGNATION OF AUTHORIZED REPRESENTATIVE/ ASSIGNMENT OF BENEFITS.

AS PARENT / LEGAL GUARDIAN: I HAVE READ AND UNDERSTAND THE ABOVE AND AGREE TO DESIGNATION OF AUTHORIZED BENEFITS/ASSIGNMENT OF BENEFITS

I AUTHORIZE WILDFLOWER TELEHEALTH NETWORK, INC TO CONTACT ME DIRECTLY

bottom of page