Our promise and agreement with you
One of our goals is to provide quality individualized medical care promptly. Late cancellations and No-Shows (including arriving more than 10 minutes late) inconvenience other patients as it blocks the opportunity to be seen by those who need access to medical care and delays our schedule. We understand situations arise when you may need to cancel your appointment, and we appreciate advance notice when that happens.
Please call our office at least 24 hours before your appointment to notify us if you need to reschedule or cancel the reserved time. Appointments canceled on the appointment day will be subject to a discretionary $25.00 cancellation fee.
NO-SHOWS AND LATE ARRIVALS
Patients who miss their appointment or present later than 10 minutes after scheduled appointments are considered a No Show and subject to a $50.00 No Show fee. This No-Show fee will not be submitted to insurance and is your responsibility; it must also be paid before scheduling your next appointment.
Those arriving late may be seen same day depending on the rest of the schedule for that day and if unable to be seen, may reschedule for another day.
Patients who ‘No Show’ up two (2) times may see limitations to accessing future appointments, i.e., leaving a credit card on file to charge a fee. Thank you for understanding; we understand that exceptional, unavoidable circumstances may cause you to cancel with short notice. Please let us know if this happens. In these instances, the fee may be waived at the practice discretion and previous incidences.
Prescriptions fall into three categories: (1) a request for a new medication; (2) a renewal for which there is an existing medication where there is no outstanding approval or where the approval period has expired, and (3) a refill for which there is a standing approval already documented and available for dispensing by the pharmacy.
The Practice encourages patients to contact their pharmacy directly to determine if a refill has been approved and to request dispensing accordingly. Patients are directed to contact the Practice if no more refills are available or if the request is for a new prescription.
The treating physician or advanced practice provider is responsible for determining the best course of medical care and pharmacological treatment for the patient.
The Practice schedules an appointment for a patient requesting a new medication. Requests for a new prescription or from a patient not seen for more than one year are not honored over the telephone, portal, or other means. Specific new prescriptions are not permitted over the telephone, even when a patient has been seen, such as controlled substances and certain high-risk medications as determined by the physicians and advanced practice providers (see below).
The Practice schedules an appointment for a patient requesting a renewal of an existing medication if the patient has not been seen for more than one year.
All patient requests made by telephone, portal, or other communication are documented in the patient’s medical record. The documentation includes detailed information about the medication, instructions provided to the patient, and identifying the employee filling the request.
The Practice accepts renewal requests via secure electronic communication through its patient portal or the Rx refill voicemail box. Morning requests are checked and processed immediately but no later than noon every business day, and afternoon requests are checked and processed by 5:00 p.m. every business day. Requests received after 4:00 p.m. are handled the following business day morning.
Controlled substances require an evaluation for renewal at least every six months per Florida statutes; more frequent visits may be determined by the treating physician based on the condition treated. Controlled substances for treating mental health conditions can be refilled via Televisit. Controlled substances for treating chronic pain or other non-mental health conditions require an in-person visit.
The patient must contact the pharmacy or Practice before running out of medications. All refills are managed with the same urgency.
It is the policy of the Practice to abide by all applicable rules and regulations regarding referrals, preauthorizations, and pre-certifications for the insurance companies with which it participates. This includes, but is not limited to, requiring a face-to-face evaluation or requesting medical records for patients without a visit in the last 30 days or if there has not been a visit to address the issue originating the referral.
Before sending the referral, all attempts will be made to satisfy the patient’s insurance requirements.
The practice lists preferred clinicians per specialty, but patients can request a clinician of their choice.
Once the condition and appropriate ICD-10 code are selected and information gathered, a referral order will be entered in the system for the Patient Care Coordinator to fax within 48 hours of order creation.
Patients will be provided a copy of the referral order for their records and follow-up.
Patients whose insurances require prior authorization or request clinicians out of their network should expect a lengthening of this process to allow for insurance approval.
The management has approved the policies listed herein to provide our patients with the finest care and services at the best cost.
The services delivered by this office are provided regardless of race, color, social status, national origin, handicap, or gender. We are committed to providing you with the best possible care. To accomplish this, we can assist in reading and understanding financial responsibility and our payment policy.
It is the expectation that all patients/guarantors receiving services are financially responsible for the timely payment of the charges incurred. While the office will file the verified insurance claims for payment of the bill(s) as a courtesy to the patient, the patient/guarantor is ultimately responsible for payment and agrees to pay the account(s) under the regular rates and terms of the practice in effect at present.
Payment for service is due when service is provided, and non-emergency services may be declined until the necessary payment arrangements have been accomplished. The office will accept payment in cash, checks, and all major credit/debit cards. We will happily file claims to your verified insurance policy on your behalf.
For your convenience, if your check is dishonored or returned for any reason, we will electronically debit your account the check amount plus a processing fee of $50.00. Patients paying out of pocket for the services rendered are considered self-payments.
Patients unable to comply with the Point-of-Service payment policy will be directed to the administrative office for necessary arrangements.
The practice will make a reasonable effort to assist patients in meeting their financial obligations. The office will decide on financial arrangements for payments at its discretion, based on the amount of the patient’s liability and the patient’s ability to pay based on the completed credit application.
The practice will accept “Assignment of Benefits” on verified insurance policies and submit a bill to the carrier on the patient’s behalf. It is understood that insurance is filed as a courtesy to the patient and does not relieve the patient of financial responsibility. Claims filed will be held for 45 days pending payment. The patient/guarantor will beresponsible for payment in full on all the claims not paid within the allowed period.
Because of the wide range of insurance plans in effect, the clinic will verify insurance coverage, deductibles, and other limits before acceptance for payment of services. If we cannot verify an active policy, you will be asked to pay for services at the moment of render.
Our staff is trained to assist you with insurance questions. Your employer or group health administrator is whom you should seek to address coverage issues. Although our assistance is available, we cannot mediate on your behalf.
Signing our release of information form gives us the authority to release information necessary to collect from insurance companies and other third-party payers.
Balances after insurance are due within 30 days of the insurance payments unless other satisfactory arrangements have been made with the practice.
Insurance companies cover not all services. It should be understood that by accepting the service(s), the patient is responsible for payment regardless of whether insurance covers the service.
The practice cannot become involved with any third party for financial liability matters. It must always look to the patient/guarantor to pay the bill.
The clinic reserves the right to request deposits and payments for outstanding balances. Deposits will be based on the outstanding balance plus the patient’s share of the bill for the new services.
The clinic reserves the right to file healthcare liens against the patient and other responsible parties as is deemed appropriate to protect the practice interest.
If the account is not paid in complete or satisfactory arrangements are not made within the allowable time frame, the practice reserves the right to refer the account to an attorney and a collection agency to collect the balance.
The administration and management welcome the opportunity to discuss any aspect of the financial policy. We appreciate your confidence and strive to provide quality healthcare.
The Health Insurance Portability and Accountability Act (HIPAA) safeguards your privacy. Implementation of HIPAA requirements officially began on April 14, 2003. This form is a “friendly” version. A complete text can be found at
What this is all about:
There are rules and restrictions on who may see or be notified of your Protected Health Information (PHI). These restrictions do not include the standard interchange of information necessary to provide you with office services. HIPAA provides certain rights and protections to you as a patient. We balance these needs with our goal of providing quality professional service and care. Additional information is available from the U.S. Department of Health and Human Services.
We have adopted the following policies:
Patient information will be kept confidential except as is necessary to provide services or to ensure that all administrative matters related to your care are handled appropriately. This includes sharing information with other healthcare providers, laboratories, and health insurance payers as necessary and appropriate for your care. Patient files may be stored in open file racks. They will not contain any coding that identifies a patient’s condition or information that is not already public record. The ordinary course of providing care means that such records may be left temporarily in administrative areas such as the front office and examination room. Those records will not be available to persons other than office staff. You agree to the standard procedures utilized within the office for handling charts, patient records, PHI, and other documents or information.
It is the policy of this office to remind patients of their appointments. We may do this by telephone, e-mail, U.S. mail, or any means convenient for the practice and as requested. We may send you other communications informing you of changes to office policy and new technology that you find valuable or informative.
The practice utilizes several vendors in the conduct of business. These vendors may have access to PHI but must agree to abide by the confidentiality rules of HIPAA.
You understand and agree to inspections of the office and review of documents which may include PHI by government agencies or insurance payers in the typical performance of their duties.
You agree to bring any concerns or complaints regarding privacy to the attention of the office manager or the doctor.
Your confidential information will not be used to market or advertise products, goods, or services.
We agree to provide patients access to their records following state and federal laws.
We may change, add, delete, or modify any of these provisions to better serve the needs of both the practice and the patient.
You have the right to request restrictions in using your protected health information and to request a change in specific policies used within the office concerning your PHI. However, we cannot alter internal policies to conform to your request.
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