Welcome to AVA Care!
This Booklet will help you become more familiar with AVA Care and the services we provide. It will also help explain many of our policies and procedures as well as your rights and responsibilities as our client. We make service our highest priority, and as one of Michigan’s largest case management companies we take pride in the results we achieve for those who have been injured.
AVA has a single driving mission, to identify and assist those individuals who need help most. The AVA Team consists of medical professionals who have embraced the need to balance information, justice, access, and quality care with cost-efficient healthcare delivery strategies.
We are willing to help you determine if there is actually a need for our service. If there is a need we will develop a plan that is clear, realistic, achievable, with definite timelines, and goals. If there is a need, AVA can provide referrals to community and government solutions which may assist in achieving the client goal of recovery. AVA provides and trains our case managers, care coordinators and care-givers on methods to motivate and encourage independence and autonomy.
Founded by Registered Nurses, trained in the Insurance and Health aspects of care delivery, AVA assesses the current dilemma, outlining all stakeholders, devising a fitting approach, develops a game plan for both economic and health recovery, and immediately goes to work. True success can never be achieved until all parties receive what they need most. To that end AVA orchestrates the dance between insurers, providers, hospitals, family, employer, and the injured party until optimal success is achieved.
In many instances individuals find themselves or a loved one in need of care, yet hopelessly trapped in the maize of paperwork, bureaucracy, and processes, unable to even determined how to access benefits. Or on the opposite end of the spectrum there may be a healthcare facility burdened with rising health care costs, treating an accident victim, still unsure of who will be the ultimate payer of the claim, with discharge looming. What is one to do in the shadow of this complex and fragmented health care behemoth? The answer is simple…”Call AVA”.
AVA Care has two major service categories, case management and attendant care or direct care (also known as daily living assistance).
Case Management services generally include the coordination of your care. These services generally include scheduling of doctor’s appointments, coordinating transportation services, coordinating the installation of durable medical equipment, helping the client understand doctors’ orders, writing of case management reports, interfacing with the insurance company when they need additional information about the claim, correspondence with the client relating to any questions they may have about their care, and/or the coordination of any other care you might need related to your injuries sustained in the accident.
Attendant Care is generally the assistance with the activities of daily living. This involves whatever basic care services you need; for example, personal hygiene, getting dressed, changing bandages, toileting, feeding, assistance in walking, or simply needing supervision to prevent further injury.
Not every individual is the same and not every individual has the same injuries. Therefore, our services will be specifically tailored depending on the individual situation; you will receive only the care that you want and need.
Any client can reach us at our toll free phone number 1-800-3300-AVA, or 1-800-330-0282.
You can also contact our main office at 586-566-7343.
Our mailing address is: AVA Care and Case Management, P.O. Box 183667, Shelby Township, MI 48318
In the event of a medical emergency, always call 911.
Rights and Responsibilities
You may communicate privately with whomever you wish during your medical treatment. You are also entitled to receive information relating to your treatment. In fact, AVA strongly encourages communication with your providers, and especially us, pertaining to all stages of your recovery.
Remember that AVA is here to facilitate your recovery, and if at any time you have questions relating to your care, or something is unclear, all you need to do is call and ask for information. We may need to contact you, for example to remind you of upcoming doctor’s appointments, or to get an update from you as to your needs. As such, if there is any change of address or phone numbers, be sure to contact us promptly with those changes. Consistent contact is always the best way to ensure your recovery goes as smoothly as possible.
You are in the best position to evaluate your recovery. In order to facilitate your recovery we will need information from you, especially when there are any significant changes in your medical status. Make sure to contact us when these changes occur. For example, you may need prescriptions, such as pain medications resulting from your accident. If you are running low and need help in obtaining your medication, call us and let us know so that we can set up an efficient way for you to get them. If you feel that your current treatments are not working, or if you are unhappy with your treating physician, let us know right away. You need to set up physical or occupational therapy appointments but don’t know where to begin. You may need medical equipment installed, repaired, or perhaps you no longer need it at all. In any of these events, you will need to contact us so that we can make arrangements to have the equipment installed, repaired or removed. Even if you no longer need the equipment, you will want to contact us as soon as possible so that it can be removed, or you may end up with excess costs that may not be covered by your insurance company. It is your responsibility to provide us with accurate and timely information.
Billing and Insurance
AVA Care cannot guarantee that your insurance will pay for the services provided to you. Your insurance program, not AVA Care, decides what it will and will not pay for. However, we will file a claim with your insurance company at the earliest possible date and will provide them with all the necessary information to assist them in making a payment determination. To assist us, it is important that you provide us with accurate information as promptly as possible. Incorrect or incomplete information can delay the processing of your claim. If you are unsure of your specific insurance plan requirements, it is always best to contact your insurance carrier.
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.
TO WHOM THIS NOTICE APPLIES.
This notice describes the information sharing practices of AVA care and our staff when they are providing services to you. Most of the information sharing within our organization is done for the purposes of the provision of services, to obtain payment for those services, for administrative purposes, and to evaluate the quality of care that you’ve received while you were our client. There are times, as described in this notice, when we may share information about you for other reasons.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
Each of the following categories describes how medical information about you may be used and disclosed.
- For Treatment. We may use medical information about you to provide you with services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. We may disclose medical information about you, including diagnostic results, to your primary care, and referring physicians to ensure consistency in the continuation of your care.
- For Payment. We may use and disclose medical information about you so that the services you receive at may be billed to, and payment may be collected from, an insurance company or a third party. For example, we may need to give your insurance provider information about attendant care services you receive so your insurer will pay us
or reimburse you for the services.
- For Health Care Operations. We may use and disclose medical information about you for health care operations. These uses and disclosures are necessary to run our health system and make sure that all of our clients receive quality care and services. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also disclose information to doctors, nurses, technicians, medical students, and/or other personnel for review and learning purposes.
- Client Directory/Demographics. We may include certain limited information about you in our systems directory while you are our client. This information could include your name, location in our system, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name.
- Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
- Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
- Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends about your condition if, for example, you are in the hospital. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
- As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law.
- To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
- Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
- Workers’ Compensation. We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
- Public Health Risks. We may disclose medical information about you for public health activities. These activities may include the following: Prevention or control of disease; to report child and/or senior/vulnerable persons abuse or neglect; to report reactions to medications or problems with products; to notify people of recalls of products they may
be using; to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition and as required by law.
- Health Oversight Activities. We may disclose medical information to an oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.
- Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute. As deemed appropriate and allowable, AVA Care may obtain an order protecting the information requested.
- Law Enforcement. We may release medical information to law enforcement officials. We might do this in order to help identify or locate a suspect, fugitive or material witness. Or we may release medical information when it is the subject of a subpoena or other court order.
- Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.
- National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
- Protective Services for the President and Others. We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
- Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Note: You may ask us to give you a paper copy of this notice at any time.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice throughout our system. The notice will contain the effective date on the first page. You may get a copy of our current Privacy Practices at any time by contacting the AVA Care main office as indicated below.
You may revoke your permission, in writing, at any time. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
If you have any questions or concerns regarding your privacy, please feel free to contact us toll free at 877-330-0282