Thank you for choosing AAA DME!
We are committed to providing you with quality products and superior customer service to help you live a healthier, more active life. We make it simple – we handle all your insurance paperwork we work closely with your doctor, and we deliver your medical supplies directly to your door, FREE of charge!
This Welcome Kit contains valuable information for you. We will be reaching out to you in a few days to make sure you are happy with your supplies,and to answer any questions you may have. You may also call our customer service team at 615-229-5940.
We make it easy to reorder supplies! Prior to your next order date, we will contact you by email, phone, or regular mail to get your authorization. Youcan also call us at 615-229-5940 to reorder.
As always, we are available to answer any questions you may have. Our friendly customer service team is available to speak with you Monday through Friday,10:00 AM to 6:00 PM CST. Please feel free to call us toll-free at18006137916.
AAA DME’s mission is to be the provider of choice for home delivery of quality medical supplies to people with chronic pain management needs. Our success is earned by carefullytraining and motivating our teammates, by partnering with physicians and caregivers, and by ensuring the highest level of service to our customers.
Products and Services
We provide an extensive line of Motif Breast Pumps, Belly Band, and other orthopedic braces including:
Motfi Twist Pump
LSO Back Brace
Luna Breast Pump
We also provide outstanding customer service, including:
- FREE Home Delivery
- Instruction and Support
- Reimbursement Assistance
Customer Admission Requirements
At AAA DME LLC, we accept only customers whose healthcare needs can be properly satisfied by the products and services we offer. Eligible customers must be diagnosed with a condition that can be managed and/or is treatable by the medical equipment offered by our company. Eligible customers must have health insurance coverage with benefits to cover the cost of the supplies. If you have supplemental insurance, you may be covered for any remaining portion that your primary plan does not pay. AAA DME provides free insurance verification prior to shipment of supplies.
We honor manufacturers’ warranties, including replacing, free of charge, any covered equipment that is under
warranty. If you receive any defective products, please call us at 615-229-5940.
If for any reason you would like to exchange or return products you may return it to AAA DME within thirty (30) days of the purchase date according to the policy below.
- If you ordered an item from AAA DME and we shipped the wrong item, or the item is defective, we will gladly exchange the order for the proper items provided the exchange is requested within thirty (30) days of the date of service.
- All products and packaging must be returned in the condition in which they were received in order for AAA DME LLC to process refunds. Any product(s) showing signs of wear will not be accepted for exchange or return.
- Refunds for product returns will be credited to the insurance If your insurance company paid for the order, we will send them a refund. AAA DME will only credit acustomer’s account if the order was paid for directly by the customer.
Thank you for choosing AAA DME or your medical supplies. Please call 615-229-5940 if you have any questions or concerns.
NOTICE OF PRIVACY PRACTICES
Commitment to Privacy
Your Health Information
Opry Medical is dedicated to maintaining the privacy of your healthcare information, and we adhere to laws that maintain the confidentiality of information that identifies you. Any use of healthcare information beyond the uses described below requires your individual written authorization. The Health Insurance Portability and Accountability Act (HIPAA) ensures that Opry Medical provides you with a copy of our Notice of Privacy Practices, outlining the way we safeguard your health information. Opry Medical abides by the terms of the Notice of Privacy Practices currently in effect and reserves the right to revise or amend the Notice, as needed.
Although your health record is the physical property of the healthcare provider that compiled it, the information belongs to you. You have the right to:
• Request a restriction on certain uses and disclosures of
• Obtain a paper copy of the Notice of Privacy Practices
• Obtain an accounting of your health information
• Inspect and copy your healthcare record
• Request confidential communication
• Amend your healthcare record
• Revoke your authorization to use or disclose health
information except to the extent that action has already been taken
Instances of Disclosure For Service, Payment, and Healthcare Operations
We will use your health information for service. Information obtained by our company will be documented in your record and will be used to provide you with medical
supplies. The physician’s letter of medical necessity will be part of the record and will determine the medical supplies you receive. We will use your health information for payment. In order to determine your eligibility for medical supplies, we may contact your insurance company and disclose healthcare related information. Also, we will billyou or a third-party payer for products you receive from our company. The health information that identifies you, your diagnosis, and medical supplies may be included on this bill. We will use your health information for healthcare operations. We may use your health information to evaluate the quality of service you receive from us, to conduct cost management assessments, and to plan business activities. This information is used in an effort to
AAA DME is required to:
• Maintain the privacy of your health information
• Provide you with a notice as to our legal duties and privacy practices withrespect to information we collect and maintain about you
• Abide by the terms of the Notice
• Notify you if we are unable to agree to a requested
• Accommodate reasonable requests you may have to
communicate health information by alternative means
AAA DME reserves the right to change our practices, and to make any new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to your address on file. We will not use or disclose your health information without your authorization, except for
services, payment, and healthcare operations.
continually improve the quality and effectiveness of the products and services we provide.
OTHER USES OR DISCLOSURES
There are some individuals who are under contract with AAA DME and, from timeto time, are engaged in the improvement or financial enhancement of our business. We require any business associate to appropriately safeguard your information so that your health
information is protected.
As required by law, we may disclose your health information to public health or legalauthorities charged with preventing or controlling disease, injury, or disability.
OTHER USES OR DISCLOSURES (CONTINUED)
Health Oversight Agencies
We may disclose health information for law enforcement purposes as required by law, or in response to a valid subpoena.
We may disclose health information for law enforcement purposes as required by law, or in response to a valid subpoena.
For More Information
Please contact AAA DME’s HIPAA Compliance Officer at 615-229-5940 if you require additional information, and/or want to pursue your rights, including:
- Requesting restrictions
- Inspecting and copying your record
- Securing an account of disclosure
- Requesting additional disclosures
- Revoking authorizations at any time
- Filing a complaint
CLIENT RIGHTS & RESPONSIBILITIES
NEW PATIENT WELCOME KIT
1. To receive services appropriate to your needs and expect the health care organization to provide safe, professional care at the level of intensity needed, without unlawful restriction by reason of age, sex, race, creed, color, national origin, religion or disability.
2. To have access to necessary professional services 24 hours a day, 7 days a week.
3. To be informed of services available.
4. To be informed of the ownership and control of the organization.
5. To be told on request if the organization’s liability insurance will cover injuries to employees when they are in
your home, and if it will cover theft or property damage that occurs while you are being treated.
CLIENT CARE, you have the right:
1. To be involved in your care planning, including education of the same, from admission to discharge, and to be informed in a reasonable time of anticipated terminationand/or transfer of service.
2. To receive reasonable continuity of care.
3. To be informed of your rights and responsibilities in advance concerning care and treatment you will receive including any changes, the frequency of care/service and by whom (disciplines) services will be provided.
4. To be informed of the nature and purpose of any technical procedure that will be performed, including information about the potential benefits and burdens as well as who will perform the procedure.
5. To receive care/service from staff who are qualified through education and/or experience to carry out the duties for which they are assigned.
6. To be referred to other agencies and/or organizations when appropriate and be informed of any financial benefit to the referring agency.
RESPECT AND CONFIDENTIALITY, you have the right:
1. To be treated with consideration, respect, and dignity, including the provision of privacy during care.
2. To have your property treated with respect.
3. To have staff communicate in a language or form you can reasonably be expected to understand and when possible, the organization assists with or may providespecial devices, interpreters, or other aids to facilitate communication.
4. To maintain confidentiality of your clinical records in accordance with legal requirements and to anticipate the organization will release information only with your authorization or as required by law.
5. To be informed of the organization’s policies and procedures for disclosure of your clinical record.
FINANCIAL ASPECTS OF CARE, you have the right:
1. To be informed of the extent to which payment for the health care services may be expected from Medicare, Medicaid or any other payer.
2. To be informed of changes not covered by Medicare and/or responsibility for any payment(s) that you might
have to make.
As a client, you have the responsibility:
1. To provide complete and accurate information about illness, hospitalization, medications, and other matters pertinent to your health; any changes in address, phone,or insurance/payment information; and changes made to advance directives.
2. To inform the organization when you will not be able to keep your appointment.
3. To treat the staff with respect.
4. To participate in and follow your plan of care.
5. To provide a safe environment for care to be given if care is provided in your home.
6. To cooperate with staff and ask questions if you do not understand instruction or information given to you.
7. To assist the organization with billing and/or payment issues to help with processing third party payment.
8. To inform the organization of any problems or dissatisfaction with services.
COMPLAINTS, you have the right:
To voice complaints/grievances about treatment or care that is (or fails to be) furnished, or regarding lack of respect for property without reprisal or discrimination for it and beinformed of the procedure to voice complaints/grievances with the home care organization. Complaints or questions may be registered with AAA DME in person or in writing. Theaddress: 810 Dominican Drive, Nashville, TN 37228 and phone: 615-229-5940. The organization investigates the complaint and resolution of it.
To be informed of the State Hotline. The State of Tennessee hotline for complaints or questions about local home care organizations is (615) 741-2241. The days and times ofoperation are Monday through Friday 9:00 a.m. to 5:00 p.m., except closed government agency holidays.
Full HIPAA/HITECH Privacy Practices
Equipment Instructions & Product Manuals
Terms & Conditions
I have requested professional services from AAA DME LLC DBA Music City Med LLC on behalf of myself and/or my dependents, and understand that by making this request; I am responsible for all charges incurred during the course of said services. I understand that all fees for said services are due and payable on the date services are rendered and agree to pay all such charges incurred in full immediately upon presentation of the appropriate
statement unless other arrangements have been made in advance.
Assignment of Insurance Benefits
I hereby assign all applicable health insurance benefits to which I and/or my dependents are
entitled to AAA DME LLC DBA Music City Med LLC I certify that the health insurance information that I provided
to AAA DME LLC DBA Music City Med LLC is accurate as of the date set forth below and that I am responsible for keeping it updated.I hereby authorize AAA DME LLC DBA Music City Med LLC LLC. To submit claims, on my and/or my dependent’s behalf,
to the benefit plan (or its administrator) listed on the current insurance card I provided to AAA DME LLC DBA Music City Med LLC in good faith. I also hereby instruct my benefit plan (or its administrator) to pay AAA DME LLC DBA Music City Med LLC directly for services rendered to me or my dependents. To the extent that my current policy prohibits direct payment to AAA DME LLC DBA Music City Med LLC, I hereby instruct and
direct my benefit plan (or its administrator) to provide documentation stating such non-assignment to myself and AAA DME LLC DBA Music City Med LLC upon request. Upon proof of such non-assignment, I instruct my benefit plan (or its administrator) to make the check payable to me and mail it directly to AAA DME LLC DBA Music City Med LLC – 810 Dominican Drive, Nashville, TN, 37228.I am fully aware that having health insurance does not absolve me of my responsibility to ensure that my bills for professional services from AAA DME LLC DBA Music City Med LLC are paid in full. I also
understand that I am responsible for all amounts not covered by my health insurance, including
co-payments, co-insurance, and deductibles.
Authorization to Release Information
I hereby authorize AAA DME LLC DBA Music City Med LLC to: (1) release any information necessary to my health
benefit plan (or its administrator) regarding my illness and treatments; (2) process insurance
claims generated in the course of examination or treatment; and (3) allow a photocopy of my signature to be used to process insurance claims. This order will remain in effect until revoked by me in writing.
I hereby designate, authorize, and convey to AAA DME LLC DBA Music City Med LLC LLC. To the full extent permissible under law and under any applicable insurance policy and/or employee health care benefit plan: (1) the right and ability to act on my behalf in connection with any claim, right, or cause in action that I may have under such insurance policy and/or benefit plan; and (2) the right and ability to act on my behalf to pursue such claim, right, or cause of action in connection with said insurance policy and/or benefit plan (including
but not limited to, the right to act on my behalf in respect to a benefit plan governed by the
provisions of ERISA as provided in 29 C.F.R. §2560.5031(b)(4) with respect to any healthcare expense incurred as a result of the services I received from AAA DME LLC DBA Music City Med LLC and, to the extent permissible under the law, to claim on my behalf, such benefits, claims, or reimbursement, and any other applicable remedy, including fines.
A photocopy of this Assignment/Authorization shall be as effective and valid as the original.
Signature of Policyholder / Insured Date