Birch Lake Chiropractic Clinic

Content Applies To: Birch Lake Chiropractic Clinic, LLC

Scope

Any person on the basis of race, color, creed, religion, gender, marital status, sexual orientation, gender identity or expression, veteran’s status, status with regard to public assistance, national origin, disability, or age in admission to, participation in, or receipt of the services and benefits under any of its programs and activities.

Purpose

To ensure compliance with the Federal and State laws that prohibit discrimination.

Policy Statements

As a recipient of Federal financial funds under Medicare Part B, Birch Lake Chiropractic Clinic, LLC does not exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, creed, religion, gender, marital status, sexual orientation, gender identity or expression, veteran’s status, status with regard to public assistance, national origin, disability, or age in admission to, participation in, or receipt of the services and benefits under any of its programs and activities.

Birch Lake Chiropractic Clinic, LLC only receives Federal financial funds under Medicare Part B. Therefore, we are exempt from paying for or providing qualified interpreters.

Reference: Medicare.gov, section 3 – Find out if Medicare covers your test, service or item – pg. 41. “Chiropractic services (limited coverage) Medicare covers manipulation of the spine if medically necessary to correct a subluxation (when one or more of the bones of your spine move out of position) when provided by a chiropractor or other qualified provider. You pay 20% of the Medicare-approved amount, and the Part B deductible applies. Note: You pay all costs for any other services or tests ordered by a chiropractor (including X-rays and massage therapy).”

This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Regulations of the U.S. Department of Health and Human Services issued pursuant to these statutes at Title 45 Code of Federal Regulations Parts 80, 84, and 91and ACA Section 1557.

If you believe that you have been discriminated against, you can file a grievance by contacting Grant Erickson, D.C., 4635 White Bear Parkway, White Bear Lake, MN 55110, 651-429-5329.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, 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, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.