Your Patient Portal is a secure, online personal health record provided to you by Dr. Lantz’s office. Enroll today by calling our office at (712) 542-6521. If you already have a username and password for your account, click here to log in.
There are two types of insurance or benefit plans that may help pay for your eye care services and products. You may have both, and our practice accepts both:
Vision Care Plans
We are providers for VSP (Vision Service Plan), Avesis, and VCD (Vision Care Direct)
- Vision care plans only cover routine vision exams along with eyeglasses and contact lenses. Vision plans only cover a basic screening for eye disease. They do not cover diagnosis, management or treatment of eye diseases.
We are providers for MEDICARE, WELLMARK BC/BS, IOWA MEDICAID (now Amerihealth Caritas, Amerigroup IA, Inc, & UHC-Block Vision), and UNITED HEALTHCARE, however many health insurance companies allow you to go to any provider. We submit claims to nearly all medical insurance companies.
- Medical insurance must be used if you have any eye health problem or systemic health problem that has ocular complications. Your doctor will determine if these conditions apply to you, but some are determined by your case history.
- If you have both types of insurance plans, it may be necessary for us to bill some services to one plan and other services to the other. We will use coordination of benefits to do this properly and to minimize your out-of-pocket expense.
- We will bill your insurance for services. We will also try to obtain advance authorization from your insurance company for your insurance or vision benefits so we can tell you what is covered. If some fees are not paid by your plan (such as deductibles, copays, coinsurance, or benefit overages), we will collect those from you the day you are here
In addition, we also accept CARE CREDIT, which is a medical expense credit card.
It is the patient's obligation to know and understand their insurance benefits and referral requirements. We cannot be responsible for knowledge of your individual medical coverage. Please call your Insurance Benefits Office if you are unsure of your coverage. Thank you!
- Debit and Credit Cards (Discover, MasterCard and Visa)
- Medical Expense Credit Card (CareCredit)
- Flexible Spending Accounts
- Health Savings Accounts (HSA)
Notice of Privacy Practices
Daniel T. Lantz, O.D.
203 South 16th St
Clarinda, IA 51632
Jane Lantz, Privacy Officer
We respect our legal obligation to keep health information that might identify you private. We are obligated by law to provide you with notice of our privacy practices. This notice describes how we protect your health information and what rights you have regarding it.
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
The most common reasons we would use or disclose your health information is for treatment, payment, or business operations. We routinely use and disclose your medical information within the office on a daily basis. We do not need specific permission to use or disclose your medical information in the following matters, although you have the right to request that we do not.
Examples of how we might use or disclose health information for treatment purposes might include:
Setting up or changing appointments including leaving messages with those at your home or office who may answer the phone or leaving messages on answering machines, voice mails or secure emails; calling your name out in a reception room environment; prescribing glasses, contact lenses, or medications as well as relaying this information to suppliers by phone, fax or other electronic means including initial prescriptions and requests from suppliers for refills; notifying you that your ophthalmic goods are ready, including leaving messages with those at your home or office who may answer the phone, or leaving messages on answering machines, voice mails or secure emails; referring you to another doctor for care not provided by this office; obtaining copies of health information from doctors you have seen before us; discussing your care with you directly or with family or friends you have inferred or agreed may listen to information about your health; sending you postcards or letters or leaving messages with those at your home who may answer the phone or on answering machines, voice mails or secure emails reminding you it is time for continued care; at your request, we can provide you with a copy of your medical records via secure email transmission.
Examples of how we might use or disclose health information for payment purposes might include:
Asking you about your vision or medical insurance plans or other sources of payment; preparing and sending bills to your insurance provider or to you; providing any information required by third party payors in order to insure payment for services rendered to you; sending notices of payment due on your account to the person designated as responsible party or head of household on your account with fee explanations that could include procedures performed and for what diagnosis: collecting unpaid balances either ourselves or through a collection agency, attorney, or district attorney’s office.
Examples of how we might use or disclose health information for business operations might include:
Financial or billing audits; internal quality assurance programs; participation in managed care plans; defense of legal matters; business planning; certain research functions; informing you of products or services offered by our office; compliance with local, state, or federal government agencies request for information; oversight activities such as licensing of our doctors; Medicare or Medicaid audits; providing information regarding your vision status to the Department of Public Safety, a school nurse, or agency qualifying for disability status.
USES AND DISCLOSURES FOR OTHER REASONS NOT NEEDING PERMISSION
In some other limited situations, the law allows us to use or disclose your medical information without your specific permission. Most of these situations will never apply to you but they could.
- When a state or federal law mandates that certain health information be reported for a specific purpose
- For public health reasons, such as reporting of a contagious disease, investigations or surveillance, and notices to and from the federal Food and Drug Administration regarding drugs or medical devices
- Disclosures to government or law authorities about victims of suspected abuse, neglect, domestic violence, or when someone is or suspected to be a victim of a crime
- Disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of courts or administrative hearings
- Disclosures to a medical examiner to identify a deceased person or determine cause of death or to funeral directors to aid in burial
- Disclosures to organizations that handle organ or tissue donations
- Uses or disclosures for health related research
- Uses or disclosures to prevent a serious threat to health or safety of an individual or individuals
- Uses or disclosures to aid military purposes or lawful national intelligence activities
- Disclosures of de-identified information
- Disclosures related to a workman’s compensation claim
- Disclosures of a “limited data set” for research, public health, or health care operations
- Incidental disclosures that are an unavoidable by-product of permitted uses and disclosures
- Disclosure of information needed in completing form from a school-related vision screening, information to the Department of Public Safety, information related to certification for occupational or recreational licenses such as pilots license.
- Disclosures to business associates who perform health care operations for Daniel T. Lantz, O.D. and who commit to respect the privacy of your information
- Unless you object, disclosure of relevant information to family members or friends who are helping you with your care or by their allowed presence cause us to assume you approve their exposure to relevant information about your health
USES OR DISCLOSURES TO PATIENT REPRESENTATIVES
It is the policy of Daniel T. Lantz, O.D. for our staff to take phone calls from individuals on a patient’s behalf requesting information about making or changing an appointment; the status of eyeglasses, contact lenses, or other optical goods ordered by or for the patient. Daniel T. Lantz, O.D. staff will also assist individuals on a patient’s behalf in the delivery of eyeglasses, contact lenses, or other optical goods. During a telephone or in person contact, every effort will be made to limit the encounter to only the specifics needed to complete the transaction required. No information about the patient’s vision or health status may be disclosed without proper patient consent. Daniel T. Lantz, O.D. staff and doctors will also infer that if you allow another person in an examination room, treatment room, dispensary, or any business area within the office with you while testing is performed or discussions held about your vision or health care or your account that you consent to the presence of that individual.
OTHER USES AND DISCLOSURES
We will not make any other uses or disclosures of your health information unless you sign a written Authorization for Release of Identifying Health Information. The content of this authorization is determined by federal law. The request for signing an authorization may be initiated by Daniel T. Lantz, O.D. or by you as the patient. We will comply with your request if it is applicable to the federal policies regarding authorizations. If we ask you to sign an authorization, you may decline to do so. If you do not sign the authorization, we may not use or disclose the information we intended to use. If you do elect to sign the authorization, you may revoke it at any time. Revocation requests must be made in writing to the Privacy Officer named at the beginning of this Notice.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
The law gives you many rights regarding your personal health information.
You may ask us to restrict our uses and disclosures for purposes of treatment (except in emergency care), payment, or business operations. This request must be made in writing to Privacy Officer named at the beginning of this Notice. We do not have to agree to your request, but if we agree, must honor the restrictions you ask for.
You may ask us to communicate with you in a confidential manner. Examples might be only contacting you by telephone at your home or using secure email address. We will accommodate these requests if they are reasonable and if you agree to pay any additional cost, if any, incurred in accommodating your request. Requests for special communication requests must be made to the Privacy Officer named at the beginning of this Notice.
You may ask to review or get copies of your health information. There are a very few limited situations in which we may refuse your access to your health information. For the most part we are happy to provide you with the opportunity to either review or obtain a copy of your medical information. All requests for review or copy of medical information must be made in writing to the Privacy Officer named at the beginning of this Notice. While we usually respond to these requests in just a day or so, by law we have fifteen (15) days to respond to your request. We may request an additional thirty (30) day extension in certain situations.
You may ask us to amend or change your health care information if you think it is incorrect or incomplete. If we agree, we will make the amendment to your medical record within thirty (30) days of your written request for change sent to the Privacy Officer named at the beginning of this Notice. We will then send the corrected information to you or any other individual you feel needs a copy of the corrected information. If we do not agree, you will be notified in writing of our decision. You may then write a statement of your position and we will include it in your medical record along with any rebuttal statement we may wish to include.
You may request a list of any non-routine disclosures of your health information that we might have made within the past six (6) years (or a shorter period if you wish). Routine disclosures would include those used your treatment, payment, and business operations of Daniel T. Lantz, O.D. These routine disclosures will not be included in your list of disclosures. You are entitled to one such list per year without charge. If you want more frequent lists, you must pay for them in advance at a fee of $5.00 per list. We will usually respond to your written request (made to the Privacy Officer named at the beginning of this Notice) within thirty (30) days but we are allowed one thirty (30) day extension if we need the time to complete your request.
You may obtain additional copies of this Notice of Privacy Practices from our Privacy Officer named at the beginning of this Notice.
BREACH NOTIFICATION POLICY
In the event of a reportable breach of patient information, Daniel T. Lantz, O.D. agrees to abide by the breach notification requirements as established by the HIPAA Breach Notification Rule. If a breach occurs, Daniel T. Lantz, O.D. will consult with a HIPAA attorney and take all necessary steps to remain in compliance with this rule including notification of individuals, Business Associates, the Secretary of Health and Human Services and prominent media outlets.
WHISLEBLOWER PROTECTION RULE
Daniel T. Lantz, O.D. will take no action against any individual who provides information to the Office of Civil Rights, Office of the Inspector General or individual state Attorney General’s Office regarding concerns related to the privacy and security procedures or actions at Daniel T. Lantz, O.D..
CHANGING OUR NOTICE OF PRIVACY PRACTICES
By law, we must abide by the terms of this Notice of Privacy Practices until we choose to substantially change the Notice. We reserve the right to change this Notice at any time. If we change this Notice, the new privacy practices will apply to your existing health information as well as any additional information generated in the future. If we change this Notice, we will post a new Notice in our office.
If you think that anyone at Daniel T. Lantz, O.D. has not respected the privacy of your health information, you are free to complain to the Privacy Officer named at the beginning of this Notice. We are more than happy to try to resolve any concern you may have in writing. If we cannot resolve your concern at that level, you may also file a complaint with the U.S. Department of Health and Human Services, Office of Civil Rights or the Iowa Attorney General’s Office. We will not retaliate against you if you make such a complaint.
Notice of Non-Discrimination
Click Here a printable version of our Notice of Non-Discrimination
Daniel T. Lantz, O.D. understands that discrimination is against the law and complies with all applicable Federal and State civil rights laws. Specifically, we do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude patients or treat them any differently based on any of these factors.
When necessary and free of charge to the patient, Daniel T. Lantz, O.D.
- Provides aids and services to patients with disabilities when necessary to effectively communicate with them
- Provides qualified sign language interpreters for hearing impaired patients
- Provides language services to those patients who cannot effectively communicate in English. This may include qualified interpreters or written information.
If you believe Daniel T. Lantz, O.D. has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you may file a grievance with:
203 South 16th St
Clarinda, Iowa 51632
You may file your grievance in person, by mail, fax or email. If you need assistance filing a grievance, Jane Lantz is available to assist you.
You may also file a civil rights complaint with the US Department of Health and Human Services, Office for Civil Rights two ways:
- Electronically through the Office of Civil Rights Complaint Portal:
- By mail or phone at:
US Department of Health and Human Services
200 Independence Avenue SW Room 509F, HHH Building
Washington, DC 20201
1-800-368-1019 1-800-537-7697 (TDD)
Complaint forms are available at:
Availability of Language Assistance
Non-Discrimination Grievance Procedures
It is the policy of Daniel T. Lantz, O.D. to not discriminate on the basis of race, color, national origin, sex, age or disability. Daniel T. Lantz, O.D. has adopted an internal grievance resolution procedure for prompt and equitable resolution of any allegation of discrimination as prohibited by Section 1557 of the Affordable Care Act. These actions may be examined by any patient by contacting Jane Lantz:
203 South 16th St
Clarinda, Iowa 51632
Any person who believes someone has been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for Daniel T. Lantz, O.D. to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance.
- Grievances must be submitted to the Grievance Coordinator within (60 days) of the date the person filing the grievance becomes aware of the alleged discriminatory action.
- A complaint must be in writing, containing the name and address of the person filing it. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought.
- The Grievance Coordinator (or her/his designee) shall conduct an investigation of the complaint. This investigation may be informal, but it will be thorough, affording all interested persons an opportunity to submit evidence relevant to the complaint.
- The Grievance Coordinator will maintain the files and records of Daniel T. Lantz, O.D. relating to such grievances. To the extent possible, and in accordance with applicable law, the Grievance Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know.
- The Grievance Coordinator will issue a written decision on the grievance, based on a preponderance of the evidence, no later than 30 days after its filing, including a notice to the complainant of their right to pursue further administrative or legal remedies.
- The person filing the grievance may appeal the decision of the Grievance Coordinator by writing to Daniel T. Lantz, O.D. within 15 days of receiving the Grievance Coordinator’s decision. Daniel T. Lantz, O.D. shall issue a written decision in response to the appeal no later than 30 days after its filing.
Daniel T. Lantz, O.D. will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.
The availability and use of this grievance procedure does not prevent a person from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the U.S. Department of Health and Human Services, Office for Civil Rights. A person can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at:
or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019 1-800-537-7697 (TDD)