INSIGHT HEALTH CLINIC LLC
2055 E. Southern Ave., Suite B, Tempe, AZ 85282
Phone: (928) 554-2550 | Fax: (949) 543-2787
MedicalRecords@InsightHealthClinic.com | InsightHealthClinic.com
Effective / Revised: September 20, 2026
SECTION 1 — NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our responsibility.
Insight Health Clinic LLC (IHC) is required to protect the privacy and confidentiality of your protected health information (PHI), provide you with this Notice, follow the Notice currently in effect, and notify you as required by law if a breach compromises the privacy or security of your information.
How We May Use or Disclose Your Information
For treatment, including coordinating care, prescriptions, laboratory services, referrals, consultations, and communication with other healthcare professionals involved in your care.
For payment, including billing, eligibility or benefit verification, claim submission, and collection of amounts owed for services.
For healthcare operations, including quality review, compliance, training, business administration, and activities necessary to operate the practice.
When required or permitted by law, including public health activities, reporting suspected abuse or neglect, health oversight, lawful judicial or administrative proceedings, certain law-enforcement activities, workers’ compensation matters, and other legally authorized disclosures.
To persons involved in your care or payment for your care when permitted by law and consistent with your preferences.
Information Requiring Additional Protection
Certain information may receive additional protection under federal or Arizona law, including psychiatric or mental-health information, substance-use-disorder records, HIV-related information, genetic information, and other specially protected records. IHC will follow the more protective law when it applies.
Your Privacy Rights
Request access to or copies of records maintained by IHC as described below.
Request an amendment to information you believe is incorrect or incomplete. IHC may deny the request when permitted by law and will provide notice of the decision when required.
Request confidential communications by a reasonable alternative means or at an alternative location.
Request restrictions on certain uses or disclosures. IHC is not required to agree to every restriction except where applicable law requires it.
Request an accounting of certain disclosures of your PHI.
Obtain a paper copy of this Notice at any time.
Authorize another person to act as your legally recognized personal representative.
Medical Records Access
Patients may request copies of medical records authored, created, and/or produced by Insight Health Clinic LLC and maintained by the practice. When IHC is serving as records custodian for Healthy Wings LLC, this includes records authored, created, and/or produced by Healthy Wings LLC.
IHC does not reproduce or re-release records received from outside healthcare providers, hospitals, facilities, laboratories, or other third parties when IHC did not originate those records and cannot independently validate their source or accuracy. Patients should request those records directly from the healthcare provider or organization that originated them.
Medical-record requests must follow the practice’s Medical Records Request process and will be managed within the time limit required by applicable law. Where permitted, printed copies are charged at $0.50 per page. Requests should be directed to MedicalRecords@InsightHealthClinic.com or faxed to 949-543-2787.
Authorizations
Uses or disclosures of PHI that are not otherwise permitted or required by law generally require your written authorization. You may revoke an authorization in writing, except to the extent IHC has already acted in reliance on it or as otherwise permitted by law.
Complaints and Changes to This Notice
You may raise a privacy concern or complaint with IHC without retaliation. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. IHC may revise this Notice and make the revised Notice effective for PHI it already maintains as well as information received in the future. The current Notice will be available in the clinic and on applicable IHC websites.
SECTION 2 — SMS, EMAIL & MOBILE COMMUNICATIONS NOTICE
Mobile Information Privacy. No mobile information will be shared with third parties or affiliates for marketing or promotional purposes. Text-messaging originator opt-in data and consent will not be shared with third parties for their marketing or promotional purposes.
Disclaimer: By providing your contact information to Insight Health Clinic LLC, You acknowledge and give your explicit consent to be contacted via SMS and to receive Emails for various purposes related to the healthcare services provided by Insight Health Clinic LLC and/or its Healthcare Professionals, which may include from time to time marketing and promotional content.
Message and data rates may apply.
Message frequency may vary.
Reply STOP to opt-out.
Refer to this Privacy Policy for more information.
SMS TERMS AND CONDITIONS — APPOINTMENT COMMUNICATIONS
Insight Health Clinic LLC sends appointment confirmations, reminders, scheduling updates, intake-form links, and secure deposit-payment links to patients who opt in to this messaging program. This program does not send marketing or promotional messages.
Message frequency varies according to your appointments and requests. Message and data rates may apply. Consent to receive texts is optional and is not a condition of receiving healthcare services.
Reply STOP to unsubscribe from this messaging program. Reply HELP for assistance, or call Insight Health Clinic at 928-554-2550. After opting out, you may contact the clinic to receive appointment information through another available method.
Mobile information and text-message opt-in data will not be shared with third parties or affiliates for their marketing or promotional purposes.
Text messages may not be encrypted. Avoid sending sensitive medical information or payment-card details by text. Use the secure payment link provided by the clinic.
SECTION 3 — PATIENT PAYMENT & REFUND POLICY
This policy explains patient financial responsibilities for scheduled office and telehealth encounters with Insight Health Clinic LLC. By receiving services, the patient or responsible party agrees to the applicable financial terms below.
Insurance and Benefits. IHC participates with selected insurance plans. Patients are responsible for understanding their benefits and for providing accurate, current insurance information. If coverage cannot be verified or IHC does not participate with the plan, payment may be required before services are provided.
Payment Before Services. Copayments, deductibles, coinsurance, self-pay charges, prior balances, and other known patient-responsibility amounts are due before services are rendered unless an approved payment arrangement has been made in advance.
New Patient Self-Pay Deposit. New patients scheduling Medical or Psychiatric Mental Health services as self-pay patients must pay a $75 deposit within four (4) hours of booking to retain their appointment. If the deposit is not received within that period, the appointment is subject to automatic cancellation. Deposits are refundable only when the appointment is cancelled at least twenty-four (24) hours before its scheduled start time. Deposits are non-refundable for cancellations made less than twenty-four (24) hours before the appointment or for missed appointments.
Payment Method on File. A valid approved payment method is required to reserve and maintain appointments. You authorize IHC and its designated billing partners to charge the payment method on file for amounts you owe, including copayments, deductibles, coinsurance, non-covered services, late-cancellation or missed-appointment fees, and balances assigned to you after insurance processes a claim.
Proof of Identity and Insurance. Patients must complete required registration information and provide valid government-issued photo identification and current insurance information when applicable. Incorrect, incomplete, inactive, or outdated information may result in patient responsibility for charges.
Balances After Insurance. You remain responsible for amounts assigned to you by your insurer, subject to applicable law and payer contracts. Patients are responsible for timely responding to insurer requests, including coordination-of-benefits requests.
Fees Are for Professional Services. Fees are charged for the provider’s and/or professional staff member’s time, expertise, evaluation, medical decision-making, and services provided—not for a guaranteed prescription, controlled substance, referral, laboratory order, diagnosis, letter, form, or specific outcome. Medications and other clinical services are provided only when clinically appropriate and safe based on professional judgment.
Cancellation / No-Show Fee. Appointments cancelled or rescheduled within twenty-four (24) hours of the scheduled appointment time, for any reason, and missed appointments are subject to a $75.00 fee. The fee must be resolved before another appointment is confirmed unless an approved payment arrangement has been made.
Refund Policy. Fees are non-refundable once professional services have commenced or have been provided. Late-cancellation and missed-appointment fees are non-refundable once accurately assessed under this policy. Duplicate payments, confirmed overpayments, or amounts collected in error will be refunded or credited after account review.
Payment Arrangements and Delinquent Accounts. Payment arrangements must be requested and approved in advance. Unpaid balances may result in suspension of scheduling, authorized fees, collection activity, or discharge from the practice in accordance with applicable law and payer requirements.
Practice Scope. IHC is a scheduled outpatient medical and psychiatric practice. IHC is not an emergency department, hospital, crisis center, or urgent care center and does not provide emergency or urgent services. For a medical or psychiatric emergency, call 911 or go to the nearest emergency department.
The current version of these policies are available in the clinic and on websites maintained by Insight Health Clinic LLC.