Thank you for choosing Advanced Skin & Laser Center (ASLC) and Binhlam Aesthetics (BA) for your care. We are dedicated to providing exceptional clinical service and believe that clear communication of financial responsibilities is an essential part of the patient’s experience. Please review this document carefully and retain it for your records.
We accept traditional Medicare and select commercial insurance plans. Please confirm participation with our staff prior to your visit. Patients are responsible at the time of service for:
Failure of an insurance carrier to pay does not remove financial responsibility from the patient.
Dr. Binhlam and/or our Providers may order laboratory analysis of tissue for diagnostic purposes. The analysis of these specimens is then performed by a board-certified Dermatopathologist who specializes in the microscopic diagnosis of skin disorders. Charges for these services are billed by the lab or submitted to your insurance.
Appointments are scheduled based on provider availability. Members receive Preferred Scheduling Access in accordance with membership terms.
Deposits:
Cancellation Requirements
Definitions (applies to all appointment types):
Cancelation & No-Show Fee Schedule Office Visits:
ASLC Cosmetic Reservations:
ASLC Medical Surgical Appointments:
Deposit Refunds:
Medical records are available through the patient’s portal. Patients or authorized representatives may request paper or electronic copies of records and may request completion of external documentation. Requests must be submitted in writing and accompanied by appropriate identity verification and authorization where applicable.
Records will be provided within twenty (20) working days following receipt of a written request and applicable fees.
Fees may be charged up to the following limits in accordance with Tennessee law:
Medical records transmitted directly to another treating healthcare provider for continuity of care are provided without charge.
Payments made by credit card are subject to fees based on the type of service rendered:
These fees reflect the cost of credit card payment processing and are not retained as revenue for clinical services.
Balances not resolved within 30 days may be assigned to collections. Patients are responsible for all associated collection costs, legal fees, and court expenses where applicable.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
The Health Insurance Portability & Accountability Act of 1996, as amended by the HITECH Act and the final omnibus rule (“HIPAA”), is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. HIPAA gives you significant rights to understand and control how your health information is used. HIPAA provides penalties for covered entities and business associates that misuse personal health information.
As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.
The following are situations where the law allows us to make use or disclosure of your health information without obtaining your permission:
We may use and disclose your medical records for each of the following purposes: treatment, payment, and health care operations.
We may also create and distribute de-identified health information by removing all references to individually identifiable information.
We may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you without your prior authorization unless such communications are considered to be “marketing” as described below.
In some instances, we may contract with business associates for the payment and health care operations services we provide. For example, we may use an outside company to administer and manage the Plan. We may disclose your health information to our business associates so that they can perform the work that we ask them to. However, to protect your health information, we require that our business associates protect the privacy of your information and HIPAA requires that they do so as well.
We may use or disclose health information if the law requires us to use or disclose it for certain reasons. We may also disclose health information if a state law requires us to audit or monitor situations and for licensing or certifying health care facilities or professionals.
We may disclose your health information to public health authorities that need the information to prevent or control disease, injury, or disability or handle situations where children are abused or neglected.
We may disclose health information when there are problems with a product that is regulated by the FDA. For instance, when the product has harmed someone, is defective, or needs to be recalled, we may disclose certain information.
We may disclose health information to a person who has been exposed to a communicable disease or may be at risk of spreading or contracting a disease or condition. Employment-Related Situations. We may disclose health information to an employer when the employer is allowed by law to have that information for work-related reasons. We may also disclose health information for workers’ compensation programs.
We may disclose health information to appropriate authorities if we have reason to believe that a person has been a victim of abuse, neglect, or domestic violence.
We may disclose health information so that government agencies can monitor or oversee the health care system and government benefit programs and be sure that certain health care entities are following regulatory programs or civil rights laws like they should.
We may disclose health information in a court or other type of legal proceeding if it is requested through a legal process, such as a court order or a subpoena.
We may disclose health information to law enforcement if it is required by law; if needed to help identify or locate a suspect, fugitive, material witness, or missing person; if it is about an individual who is or is suspected to be the victim of a crime; if we think that a death may have resulted from criminal conduct; or if we think the information is evidence that criminal conduct occurred on our premises.
We may use or disclose health information to coroners, medical examiners, or funeral directors so that they can carry out their responsibilities.
We may use or disclose health information to organizations involved in organ donation or organ transplants.
We may use or disclose health information for research purposes if the privacy of the information will be protected in the research.
We may use or disclose your health information to appropriate persons or authorities if we have reason to believe it is needed to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
We may use or disclose health information to the federal government for military purposes and activities, national security, and intelligence, or so it can provide protective services to the U.S. President or other official persons.
We may disclose health information about a person in a prison or other law enforcement custody situation for health, safety, and security reasons.
We may disclose health information to a family member, other relative, close personal friend, or any other individual you identify if that information is relevant to their involvement in paying for your health care. If possible, we will inform you in advance and allow you to prohibit or limit the disclosure of information to such persons.
We may disclose health information to the Company as the Plan Sponsor of the Plan.
Communications of health information for the purpose of “marketing” generally require your authorization. A communication about a product or service that encourages you to purchase or use the product or service is considered “marketing.” A “marketing” communication requires your authorization, unless the Plan receives no financial remuneration for the communication and the communication relates to (i) a health-related product or service provided by the Plan to you, (ii) your treatment or (iii) case management or coordination for your benefits under the Plan. In addition, “marketing” does not include refill reminders or other communications about a drug or biologic that is currently being prescribed to you, only if any financial remuneration received by the Plan in exchange for the communication is reasonably related to the Plan’s cost of making the communication (i.e., the Plan is not making a profit on the disclosure). The Plan will never sell your protected health information without your authorization.
Any other uses and disclosures will be made only with your written authorization. Additionally, the Plan will not use or disclose genetic information for underwriting purposes. You may revoke any authorization you provide in writing, and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Privacy Officer:
We are required by law to maintain the privacy of your protected health information and to provide you with this notice of our legal duties and privacy practices with respect to protected health information.
This notice is effective as of January 2022, and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may request a written copy of a revised Notice of Privacy Practices from this office.
You have recourse if you feel that your privacy protections have been violated by us. You have the right to file a formal, written complaint with us at the address below, or with the Department of Health & Human Services, Office for Civil Rights, about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint.
1649 Westgate Circle,
Brentwood, TN 37027
Sonia Romero - Pracice Manager
Email: sromero@advancedskinlaser.com
Phone: 615-843-7546
The U.S. Department of Health & Human Services Office for Civil Rights
200 Independence Avenue, S.W. Washington, D.C. 20201
Brentwood, TN 37207
Sonia Romero - Pracice Manager
Email: www.hhs.gov/ocr/privacy/hipaa/complaints
Phone: (202) 619-0257 Toll Free: 1-877-696-6775
Curated membership experiences designed to elevate your care through personalized treatment planning, exclusive benefits, and long-term skin health.
Physician-performed cosmetic treatment planning
Complimentary annual Jeuveau benefit
Preferred member pricing on eligible physician cosmetic services
Rewards on qualifying cosmetic purchases
Birthday privilege
Dedicated care coordination
Priority scheduling
Exclusive member events and promotions
Physician-performed care
Comprehensive medical evaluations
Personalized treatment planning
GLP-1 therapy when medically appropriate
Routine follow-up appointments
Ongoing education and support
Progress monitoring and accountability
Monthly treatment credit
Preferred member pricing
Annual comprehensive skin review
Rewards program
Birthday privilege
Priority scheduling
Exclusive member-only promotions
Increased monthly treatment credit
Enhanced preferred member pricing
Two annual comprehensive skin reviews
Expanded rewards program
Premium birthday privilege
Priority scheduling
Exclusive member experiences
Fill out the form below to request your appointment. Our team will contact you to confirm the details.
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