Policies & Agreements
Polices and Agreements
PRIVACY POLICY &
NOTICE OF PRIVACY PRACTICE
Effective Date: March 16, 2026
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.
At Idaho Medical Massage, we are committed to protecting the privacy and confidentiality of your Protected Health Information (PHI). PHI includes information that can be used to identify you and relates to your past, present, or future physical or mental health or condition and related healthcare services.
1. Our Legal Duty
We are required by applicable federal and state law, including the Health Insurance Portability and Accountability Act (HIPAA), to maintain the privacy of your PHI. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your PHI. We must follow the privacy practices that are described in this Notice while it is in effect.
2. Collection of Information (What We Collect)
To provide clinically focused medical massage and to meet legal and insurance requirements, we may collect and create PHI and other personal information, including:
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Contact and identifying information: name, date of birth, address, phone number, email address, emergency contact, and (when needed) photo ID.
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Insurance and billing information: insurance carrier, member/group numbers, claims information, referral/prescription information (if applicable), payment history, and related documentation needed for reimbursement.
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Health and clinical information: health history and intake forms, symptoms and functional limitations, diagnoses (when provided), medications (as relevant), allergies (as relevant), contraindications/precautions, and treatment goals.
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Clinical notes and records we create: treatment plans, session notes, progress notes, outcomes, and communications related to coordinating your care (for example, communicating with your physician or another provider at your request or as clinically appropriate).
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Communications with us: messages or emails you send, scheduling details, and administrative notes related to your care.
3. Uses and Disclosures of Health Information (How We Use It)
We use and disclose PHI for treatment, payment, and healthcare operations as allowed by HIPAA and applicable law.
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Treatment (Coordinating Care): We may use or disclose your PHI to provide, coordinate, or manage your medical massage therapy and related services. For example, we may consult with your referring physician, primary care provider, or other specialists (with your authorization when required) to ensure our clinical treatment plan for neck pain, sciatica, or whiplash is coordinated with your overall care.
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Payment (Insurance Billing): We may use and disclose your PHI so that the treatment and services you receive at Idaho Medical Massage may be billed to and payment may be collected from you, an insurance company, or a third party. This includes verifying coverage, obtaining authorizations (when required), processing claims, responding to payer requests, and documenting medical necessity and outcomes for reimbursement.
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Healthcare Operations: We may use and disclose your PHI in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, case management and care coordination, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner performance, conducting training programs, accreditation, certification, licensing, or credentialing activities, and business planning and administrative activities necessary to run the practice.
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Treatment: We may use or disclose your PHI to provide, coordinate, or manage your medical massage therapy and related services. For example, we may consult with your referring physician, primary care provider, or other specialists to ensure our clinical treatment plan for neck pain, sciatica, or whiplash is coordinated with your overall medical care.
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Payment: We may use and disclose your PHI so that the treatment and services you receive at Idaho Medical Massage may be billed to and payment may be collected from you, an insurance company, or a third party. This includes verifying insurance coverage, processing claims, and justifying the medical necessity of our outcome-based treatments.
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Healthcare Operations: We may use and disclose your PHI in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner performance, conducting training programs, accreditation, certification, licensing, or credentialing activities.
4. Secure Communications & Business Associates (BAAs)
We utilize third-party vendors to provide certain services, such as HIPAA-compliant Electronic Health Records (EHR), secure email, and secure digital faxing.
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Business Associate Agreements (BAAs): In accordance with HIPAA, we maintain signed Business Associate Agreements (BAAs) with our vendors when required. These contracts require vendors to appropriately safeguard PHI and to use it only as permitted by HIPAA and the agreement.
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Secure technology and encryption: Our systems are selected for security features designed to help protect PHI. This may include encryption in transit and/or at rest, access controls, audit logs, secure user authentication, and secure storage.
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Important note about standard email/texting: If you choose to communicate with us through standard (non-secure) email or text, there is some risk that information could be intercepted. If you request unsecure communication, we will document your preference and use reasonable safeguards, but you understand the potential risks.
5. Disclosures (When We May Share Information)
In addition to treatment, payment, and healthcare operations, we may disclose PHI in the following situations as permitted or required by law:
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With other healthcare providers: For example, with physicians, specialists, or other providers involved in your care to coordinate treatment (and with your authorization when required).
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With insurers and payers: To verify benefits, obtain authorizations (when required), submit claims, support medical necessity, and respond to audits or requests for additional information.
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As required by law: We may use or disclose PHI when we are required to do so by law (for example, certain reporting obligations).
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Public health and safety activities: We may disclose PHI for public health activities, such as to prevent or control disease, injury, or disability, or as otherwise permitted for public health and safety purposes.
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Legal proceedings: We may disclose PHI in response to a court or administrative order, and in certain circumstances in response to a subpoena, discovery request, or other lawful process, consistent with applicable legal requirements.
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Law enforcement: We may disclose PHI for law enforcement purposes as permitted by law and when legal requirements are met.
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Coroners/medical examiners/funeral directors: We may disclose PHI to a coroner, medical examiner, or funeral director as permitted by law.
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To avert a serious threat: We may disclose PHI when necessary to prevent or lessen a serious and imminent threat to health or safety, consistent with HIPAA and applicable law.
6. Your Rights (Patient Rights)
You have the following rights regarding your PHI (some rights may be subject to exceptions under HIPAA and other applicable laws):
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Right to inspect and copy (Access): You have the right to look at or get copies of your PHI, with limited exceptions. You must make a request in writing to obtain access to your PHI. We may charge a reasonable, cost-based fee as allowed by law (for example, for copies, supplies, postage, or preparation of an explanation or summary if you agree to one).
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Right to request an amendment: You have the right to request that we amend your PHI if you believe it is incorrect or incomplete. Your request must be in writing and must explain why the information should be amended. We may deny your request under certain circumstances (for example, if we did not create the record or if we believe the information is accurate and complete).
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Right to an accounting of disclosures: You have the right to receive a list of certain disclosures we made of your PHI for purposes other than treatment, payment, healthcare operations, and certain other activities for up to the last 6 years, as allowed by HIPAA.
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Right to request restrictions: You have the right to request additional restrictions on our use or disclosure of your PHI. We are not required to agree to all requested restrictions, but if we do agree, we will follow the restriction (except in an emergency or as otherwise permitted by law).
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Right to request confidential communications: You have the right to request that we communicate with you about your PHI by alternative means or at an alternative location (for example, sending mail to a P.O. Box instead of a home address). You must make your request in writing.
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Right to a paper copy of this Notice: If you receive this Notice electronically (for example, on our website or by email), you have the right to request a paper copy.
7. Security Measures (How We Protect PHI)
We take reasonable administrative, physical, and technical safeguards to protect PHI. Safeguards may include:
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Encryption and secure transmission where available/appropriate (for example, secure EHR systems and secure email/fax solutions).
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Access controls (limiting access to PHI to people who need it to do their job), unique user credentials, and authentication controls.
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Secure storage of electronic and paper records, and secure disposal when records are no longer needed.
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Workforce privacy practices and procedures designed to reduce improper access, use, or disclosure.
No system can be guaranteed 100% secure; however, we work hard to use and maintain security measures appropriate for a healthcare practice.
8. Our Duties Regarding PHI
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Privacy protections: We are required by law to maintain the privacy of PHI and to provide individuals with notice of our legal duties and privacy practices with respect to PHI.
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Breach notification: We are required to notify you following a breach of unsecured PHI as required by law.
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Policy changes: We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We will post the new notice on our website and in our office.
9. Contact (Questions or Privacy Concerns)
If you want more information about our privacy practices or have questions or concerns, please contact our Privacy Contact.
If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI or in response to a request you made to amend, restrict, or account for disclosures of your PHI, you may complain to us using the contact information listed below. You also may submit a written complaint to the U.S. Department of Health and Human Services. We support your right to the privacy of your PHI. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
Privacy Contact Information:
Idaho Medical Massage
Attn: Amber, Owner
Website: www.idahomedicalmassage.com
Email: amber@idahomedicalmassage.com
FEE & PAYMENT POLICY
Effective Date: March 16, 2026
1. Purpose and Scope
This Fee and Payment Policy ("Policy") establishes the financial responsibilities of patients and the billing practices of Idaho Medical Massage. Our goal is to provide transparent, outcome-based clinical treatment for chronic pain and dysfunction while maintaining compliance with state and federal healthcare regulations.
2. Standard Fee Schedule
Idaho Medical Massage maintains a single, uniform fee schedule for all services provided ("Master Price List" or "Master Fee Schedule"), regardless of the patient’s insurance status. The standard 60-minute Master Rate is $80. Fees are based on the services provided (including, as applicable, the complexity of the medical massage, manual therapy, and neuromuscular re-education services). Billing for all services, including those submitted to third-party payers (insurance), shall reflect these standard rates.
3. Insurance Billing and Coordination of Care
Idaho Medical Massage accepts various health insurance plans. Patients seeking to utilize insurance coverage must adhere to the following:
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Verification: While Idaho Medical Massage may assist in verifying benefits, it is the patient’s primary responsibility to confirm that massage therapy (CPT codes 97124, 97140, 97112, etc.) is a covered benefit under their specific plan.
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Prescription Requirements: For insurance reimbursement, a physician’s prescription/referral is required. Patients are responsible for ensuring a valid prescription/referral is on file.
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Patient Responsibility: Patients are responsible for all co-payments, co-insurance, deductibles, and any non-covered or non-payable services as determined by their insurance carrier. Payment of co-pays is due at the time of service.
4. Cancellation and No-Show Policy
To maintain a structured treatment plan and respect the time of our clinical staff, the following rules apply to appointments:
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Notice Period: A minimum of 24 hours' notice is required for all cancellations or rescheduling.
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Fees: Failure to provide 24 hours' notice or failure to show for a scheduled appointment could result in a "No-Show Fee" of $50.00. This fee is not billable to insurance and is the sole responsibility of the patient.
5. Payment Methods
Idaho Medical Massage accepts payment via cash, major credit cards, Health Savings Accounts (HSA), and Flexible Spending Accounts (FSA). All payments are due at the conclusion of the treatment session unless prior written arrangements have been made.
6. Tipping Policy
At Idaho Medical Massage, we operate as a clinical, healthcare-focused practice. Our services are designed to support pain relief, injury recovery, and medically oriented treatment plans.
Because of this, we do not accept tips or gratuities.
Medical massage is provided in a professional healthcare environment, similar to services provided by physicians, physical therapists, or chiropractors. Our pricing reflects the full value of the therapist’s clinical training, time, and expertise, so there is no expectation of additional payment beyond the treatment fee.
8. Compliance Statement
This policy is designed to comply with Idaho state laws and federal regulations, including the prohibition of "Dual Fee Schedules." By offering a TOS discount based on administrative savings, Idaho Medical Massage ensures equitable and legal billing practices.
Acknowledgment:
By scheduling an appointment with Idaho Medical Massage, the patient or responsible party acknowledges that they have read, understood, and agreed to the terms of this Fee and Payment Policy.
LATE ARRIVAL POLICY
Effective Date: March 16, 2026
We understand life can be unpredictable. However, our late policy helps maintain a quality experience for all clients, respecting both your time and ours.
By scheduling an appointment with Idaho Medical Massage, you acknowledge and agree to the following terms:
1. The Importance of Timeliness
Our sessions are structured to address specific diagnosed conditions and chronic pain patterns through a personalized treatment plan. Late arrivals disrupt the clinical flow and limit the therapist's ability to achieve the session’s intended therapeutic outcomes.
2. Minor Delays (Over 5 Minutes)
Arrivals beyond 5 minutes will result in a reduction of hands-on time during the session to avoid delays for subsequent clients. The full session fee still applies.
3. Significant Delays (Over 15 Minutes)
Arrivals beyond 15 minutes will need to be rescheduled and could be potentially charged a $50 fee for the scheduled appointment.
4. Communication
If you are running late, please call us as soon as possible. This allows us to make real-time adjustments and inform your therapist.
5. Recurring Late Arrivals
Clients who consistently arrive late may be asked to prepay the full price for future scheduled appointments or may no longer be scheduled at the discretion of Idaho Medical Massage.
Thank you for helping us stay on schedule and provide the best clinical care possible!
6. Acknowledgement
By signing below or booking an appointment electronically, you certify that you have read, understood, and agree to the Late Arrival & Rescheduling Policy of Idaho Medical Massage.
CANCELLATION/ NO SHOW POLICY
Effective Date: March 16, 2026
At Idaho Medical Massage, our mission is to provide clinically focused medical, therapeutic massage and manual therapies to treat and manage specific diagnosed or chronic conditions. To ensure the highest quality of care and to maintain a structured treatment plan for all our patients, we operate as a clinical healthcare facility.
Because your treatment time is reserved specifically for your clinical needs and anatomical condition, missed appointments impact not only your recovery progress but also our ability to provide care to other patients in need of pain management and mobility restoration.
1. 24-Hour Notice Requirement
We require a minimum of 24 hours’ notice for the cancellation or rescheduling of any appointment. This allows our clinical staff the necessary time to offer the vacated session to other patients on our waiting list who require urgent care for conditions such as whiplash, sciatica, or acute injury.
2. Definition of a "No-Show"
An appointment is classified as a "No-Show" under the following circumstances:
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The patient fails to arrive for a scheduled appointment without providing prior notice.
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The patient arrives more than 15 minutes late for a scheduled appointment, necessitating a reschedule as per our Late Arrival Policy.
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The patient cancels or requests to reschedule with less than 24 hours’ notice.
3. No-Show and Late Cancellation Fees
Consistent with standard healthcare and medical practice management, Idaho Medical Massage reserves the right to assess administrative fees for missed appointments:
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First Occurrence (Grace Period): We understand that emergencies and unforeseen life events happen. For your first no-show or cancellation made with less than 24 hours’ notice, we will waive any fees. We will note it on your account and reschedule your session.
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Subsequent Occurrences: For any no-show or late cancellation following your initial grace period, a $50.00 No-Show Fee will be charged to the patient’s account. This fee must be paid before or at the time of the patient’s next scheduled appointment.
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Repeated No-Shows: Patients who consistently miss appointments without notice (3 or more times) may be required to prepay for future sessions in full or may be discharged from the practice to ensure the availability of care for other patients.
4. Insurance and Financial Responsibility
Please be advised that health insurance providers (including those covering Worker’s Compensation and Personal Injury Protection) do not provide reimbursement for missed appointments or no-show fees.
The $50.00 fee is the sole financial responsibility of the patient and must be paid in full prior to the patient’s next scheduled treatment session. This fee is an administrative charge and is not a payment for clinical services rendered.
5. Medical and Emergency Exceptions
We recognize that acute illness or genuine emergencies may arise. Exceptions to this policy may be made on a case-by-case basis. Patients are encouraged to communicate with our office as soon as an emergency is identified to discuss potential fee waivers.
6. Treatment Plan Scheduling/Cancellation
All sessions within a prepaid plan are subject to the Idaho Medical Massage No-Show & Cancellation Policy and the Late Arrival & Rescheduling Policy.
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Failure to provide the required notice for a cancellation may result in the forfeiture of one (1) prepaid session from the plan balance or a late cancellation fee as outlined in the respective policies.
7. Acknowledgement
By scheduling an appointment with Idaho Medical Massage, you acknowledge that you have read and understood this No-Show & Cancellation Policy. You agree to comply with the 24- hour notice requirements and accept financial responsibility for any fees incurred due to missed appointments.
CONSENT FOR TREATMENT
Effective Date: March 16, 2026
1. Provision of Services
I, the undersigned, understand that Idaho Medical Massage provides clinically focused Medical, Therapeutic Massage and Manual Therapies. These services are specifically designed to assist in the treatment and management of pain and dysfunction, restore mobility, and improve quality of life.
2. Informed Consent for Massage Therapy
I understand that Massage therapy and manual therapy involve the manual manipulation of soft tissue (muscles, tendons, ligaments, and fascia) and may include techniques to address trigger points and myofascial restrictions.
I acknowledge the following:
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Nature of Treatment: I understand that Idaho Medical Massage provides clinically-focused Medical, therapeutic Massage and manual therapies that are designed to help treat and manage specific conditions, manage pain, and restore mobility. I acknowledge that massage therapy is not a substitute for medical examination, diagnosis, or treatment by a physician.
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Potential Benefits: In accordance with the Idaho Medical Consent Act, I understand the potential benefits of massage therapy, which may include pain relief, improved circulation, reduced muscle tension, and improved mobility.
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Potential Risks: In accordance with the Idaho Medical Consent Act, I understand there are certain risks, which may include temporary muscle soreness, bruising, skin irritation, localized swelling, or a temporary increase in symptoms.
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No Guarantee of Results: I understand that while Medical Massage is highly effective for many, Idaho Medical Massage makes no guarantees regarding the specific outcome or "cure" of any condition.
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Voluntary Consent: In accordance with the Idaho Medical Consent Act, I understand the nature of the massage procedures, the potential benefits, and the potential risks, and I voluntarily consent to treatment.
3. Scope of Practice
I understand that the massage therapists at Idaho Medical Massage are not physicians and do not diagnose medical conditions, perform spinal manipulations, or prescribe medications. I acknowledge that Medical Massage is not a substitute for a medical examination or diagnosis by a licensed physician. It is recommended that I see a physician for any physical ailments I may have.
4. Patient Responsibility and Disclosure
I agree to provide a complete and accurate health history. I will inform the therapist of any changes in my physical or medical condition. I understand that withholding medical information may pose a risk to my safety during treatment. I understand that withholding information about medical conditions (such as blood clots, recent surgeries, or inflammatory conditions) may put me at risk.
Duty to Inform / Right to Request Changes: If I experience any pain or discomfort during the session, I agree to immediately inform the therapist so that the pressure or techniques may be adjusted to my level of comfort. I understand that I have the right to request changes to the pressure or technique used, or to terminate the session at any time for any reason.
5. Professional Boundaries and Conduct
Idaho Medical Massage maintains a strictly professional and therapeutic environment.
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Draping: I understand that professional draping is required at all times. Only the area being treated will be undraped.
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Conduct: Any illicit or suggestive remarks or actions will result in immediate termination of the session, and I will be responsible for full payment.
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Therapist Right to Terminate: Likewise, the therapist has the right to terminate the session if they feel it is clinically or professionally inappropriate to continue.
6. Financial Responsibility and Insurance
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Insurance Billing: If I am using health insurance, I authorize Idaho Medical Massage to release any protected health information (PHI) necessary to process claims. I understand that I am ultimately responsible for all charges not covered by my insurance provider.
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Self-Referral: I understand that I may self-refer for treatment unless my insurance provider requires a physician’s prescription for reimbursement.
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Policies: I acknowledge that I have had the opportunity to review the company’s Privacy Policy, No-Show/Cancellation Policy, and Fee and Payment Policy.
7. Release of Liability
In consideration of the services provided by Idaho Medical Massage, I, on behalf of myself, my heirs, and personal representatives, hereby release and hold harmless Idaho Medical Massage, its owners, employees, and independent contractors from any and all liability, claims, or causes of action arising out of my participation in massage therapy sessions, except those arising from gross negligence or intentional misconduct. This includes, but is not limited to, any injuries or complications that may arise from my failure to disclose medical conditions or from the inherent risks of manual soft tissue therapy.
8. ACKNOWLEDGMENT
By signing below, I acknowledge that I have read this Consent for Treatment & Liability Waiver in its entirety. I understand the risks and benefits of Medical Massage and voluntarily choose to proceed with treatment.