Summary of the Office Policies
- PAYMENTS DUE AT TIME OF SERVICE
- All Co-pay, Deductible, and Coinsurance amounts are due at the time of service. Benefits are checked in real-time to determine the status of deductibles and out-of-pocket maximums. In the event that claims process differently than anticipated, this may result in under collection or overpayment. If this occurs, our office will either bill for balances due or provide refunds per our refund policy.
- CANCELLATION OR APPOINTMENT CHANGES
- A $50 fee will be charged for missed appointments NOT cancelled or changed within 24 hours of the appointment.
- RETURNED CHECK FEES
- A $50.00 fee will be assessed for returned checks.
- Any patient under the age of 18 must be accompanied by an adult or they will not be seen and a missed appointment fee will be due at the time of the visit.
- NOTICE OF PRIVACY PRACTICE
- Available upon request.
- Refunds are mailed from our bank. Refunds are issued once claims from all dates of service are finalized.
Detailed Office Policy
Arrival to the office:
All new patients are expected to arrive to the office 30 minutes prior to their scheduled appointment time. As a convenience, we have provided a portal on our website to submit all information prior to your visit. We also have a printable version of the forms if you would like to bring them to your visit. If you are unable to fill out the forms prior to your visit, we ask that you arrive 30 minutes prior to your scheduled appointment time.
If you are running late for your appointment, we ask that you contact the office to notify of us of your delay. We will determine whether or not your appointment will need to be rescheduled. If you arrive late to your scheduled appointment, we will make an effort to accommodate you, yet we reserve the right to reschedule that appointment. A missed appointment fee will apply.
If you are unable to make your scheduled appointment, we ask that you provide 24 hours notice to either cancel or change your appointment. If you do not contact the office within 24 hours of your appointment, then a $50 missed appointment fee will be assessed. This fee must be paid in order to reschedule your next appointment.
If your insurance requires you to have a referral, the referral must be in the office prior to the appointment or you must have the referral in your hand at the time of the visit in order to be seen. If we do not have your referral at the time of the visit, your appointment will be rescheduled and a missed appointment fee will apply. We will make every effort to remind you when a referral is required, yet keep in mind that referrals are a patient responsibility and could result in rescheduling of your appointment.
Insurance and patient responsibilities
When a healthcare provider participates with a particular insurance company, they agree to a fixed price for services rendered. This fixed-price, also known as the allowed amount, is a negotiated price between the insurance company and the provider.
In order to understand the payment process in our office, it is important to understand some of the basic terminology listed below.
What is the standard fee?
The standard fee is the amount of money that a physician charges for his or her services. The standard fee applies to services not covered by health insurance and for uninsured patients.
What is the allowed amount?
When a physician signs a contract with an insurance company, they agree to accept the amount paid by the insurance company for each service. This amount of money is known as the allowed amount. The insurance company is charged the standard fee, yet the physician is only permitted to collect the allowed amount. This money can be paid by the insurance company, the patient, or both.
What is the non-allowed amount?
The difference between the standard fee and the allowed amount is known as the non-allowed amount. The non-allowed amount, which only applies when billing an insurance company, is written off by the physician. The patient is not responsible for this money. For example, if the physician’s standard fee for an office visit is $100 and the insurance allows $60, then the non-allowed amount is $40. A payment of $60 will be made by either the insurance company, the patient, or by both the insurance company and the patient depending on the contract.
Co-payment, Co-insurance, and Deductible
Having healthcare does not mean that all of your services will be paid by the health insurance company in full. As a patient with health insurance, you sign an agreement with the health insurance carrier that you will pay your provider out of pocket expenses. These out-of-pocket expenses are termed co-payment, coinsurance, and deductible.
What is a co-payment (co-pay)?
The co-payment represents the patient’s shared cost of the allowable amount for the service. For example, if the allowed amount for a service is $100 and the co-payment is $30, then the insurance company will pay $70 and the patient will pay the $30 co-pay.
Co-payments are typically higher for specialists as compared to primary care providers.
Co-payments are due at the time of service. Patients will not be seen without paying their co-payment.
What is coinsurance?
Coinsurance represents the percentage of payment that the patient is responsible for at time of service. For example, if a patient has 80% coverage for a service, they are then responsible for 20% of the allowed amount. If the allowed amount is $100, then the patient will be responsible for $20 and the insurance company will pay $80.
Coinsurance payments are due at the time of service. Patients will not be seen without paying their coinsurance.
What is a deductible?
The deductible is the amount of money that a patient must pay out of their pocket before the insurance company will make any payment for services. For example if a patient has a $1000 deductible and the insurance company allows $100 for the services rendered on that day, then the patient is responsible for $100 and $900 remains on the deductible. The insurance company will not pay any money for services applicable to the deductible until $1000 has been paid by the patient.
Deductibles are due at the time of service. Patients will not be seen without paying their deductible.
Questions regarding office policy
If you have any questions regarding our office policy feel free to contact us at 410-431-1261 or email the office at firstname.lastname@example.org.
We have created this privacy statement in order to demonstrate our firm and continuing commitment to the privacy of personal information provided by those visiting and interacting with this website. We hold the privacy of your personal information in the highest regard. The following discloses our information gathering and dissemination practices for this website.
We recognizes the importance of protecting your privacy and our policy is designed to assist you in understanding how we collect, use, and safeguard the personal information you provide to us and to assist you in making informed decisions when using our site. This policy will be continuously assessed against new technologies, business practices, and our customers’ needs.
What information do we collect?
When you visit this website you may provide us with two types of information. First is personal information you knowingly choose to disclose that is collected on an individual basis and second is website use information collected on an aggregate basis as you and others browse our website.
1. Personal Information You Choose to Provide
When you register for any of our products, services, or newsletters you will provide us information about yourself.
If you choose to correspond with us through email, we may retain the content of your email messages together with your email address and our responses. We provide the same protections for these electronic communications that we employ in the maintenance of information received by mail and telephone.
2. Website Use Information
Similar to other commercial websites, our website utilizes a standard technology called “cookies” (see explanation below, “What Are Cookies?”) and web server log files to collect information about how our website is used. Information gathered through cookies and web server logs may include the date and time of visits, the pages viewed, time spent at our website, and the websites visited just before and just after our website.
How Do We Use the Information That You Provide to Us?
Broadly speaking, we use personal information for purposes of administering our business activities, providing the products and services you requested, to process your payment, to monitor the use of the service, our marketing and promotional efforts and improve our content and service offerings, and customize our site’s content, layout, services and for other lawful purposes. These uses improve our site and better tailor it to meet your needs.
Furthermore, such information may be shared with others on an aggregate basis. Personally identifiable information or business information will not be shared with parties except as required by law.
Occasionally, we may also use the information we collect to notify you about important changes to our website, new services, and special offers we think you will find valuable. You may notify us at any time if you do not wish to receive these offers by emailing us at the link provided on the newsletter.
What Are Cookies?
How Do We Use Information We Collect from Cookies?
IP addresses are used by your computer every time you are connected to the Internet. Your IP address is a number that is used by computers on the network to identify your computer. IP addresses are automatically collected by our web server as part of demographic and profile data known as traffic data so that data (such as the web pages you request) can be sent to you.
Sharing and Selling Information
We do not share, sell, lend or lease any of the information that uniquely identify a subscriber (such as email addresses or personal details) with anyone except to the extent it is necessary to process transactions or provide services that you have requested.
How Can You Access and Correct Your Information?
You may request access to all your personally identifiable information that we collect online and maintain in our database by emailing us at the usual address.
What About Legally Compelled Disclosure of Information?
We may disclose information when legally compelled to do so, in other words, when we, in good faith, believe that the law requires it or for the protection of our legal rights. We may also disclose account information when we have reason to believe that disclosing this information is necessary to identify, contact or bring legal action against someone who may be violating our Terms of Service or to protect the safety of our users and the Public.
What About Other Websites Linked to Our Website?
We are not responsible for the practices employed by websites linked to or from our website or the information or content contained therein. Often links to other websites are provided solely as pointers to information on topics that may be useful to the users of our website.
Our Commitment To Data Security:
Please note that your information will be stored and processed on our computers in the United States. The laws on holding personal data in the United States may be less stringent than the laws of your Country of residence or citizenship. To prevent unauthorized access, maintain data accuracy, and ensure the correct use of information, we have put in place appropriate physical, electronic, and managerial procedures to safeguard and secure the information we collect online.
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From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose this information. Information requested may include contact information (such as name and shipping address), and demographic information (such as zip code, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the use and satisfaction of this site.
A Special Note About Minors
Minors are not eligible to use our services unsupervised and we ask that minors (under the age of 18) do not submit any personal information to us. If you are a minor, you can use this service only in conjunction with permission and guidance from your parents or guardians.
Acquisition or Changes in Ownership
In the event that the website (or a substantial portion of its assets) is acquired, your information would be considered part of those assets, and may be part of those assets that are transferred.
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