Our patients' care is of utmost importance. We see patients by appointment only and schedule only a very few (8-10) patients per day. For this reason, my staff and I would appreciate at least a 48 hour notice of cancellation. Without this notice, you may be charged a fee for missing your appointment. Patients who frequently miss appointments may be discharged from our practice.
Follow-up Appointments / Telephone Calls-
Dr. Smith monitors and evaluates all follow-up and yearly check-ups. These appointments may be with a nurse or the nurse practitioner monitored by Dr. Smith. We always have a nurse available to answer phone question - if necessary the nurse practitioner or Dr. Smith will be consulted.
A charge may be billed to your account for involved phone and "drop-in" consultations.
The "Responsible Party" is considered the parent / legal guardian who typically brings the child to see the doctor - regardless of which parent provides insurance for the child. We will not bill non-custodial parents without a copy of a court order indicating that the non-custodial parent is 100% responsible. Before treating a child brought in by someone other than the parent or legal guardian, we require the parent / legal guardian sign a "permission to treat" form. All HIPAA rules apply to minor children as well as adults.
PRO0F OF INSURANCE:
Please bring your insurance card to each visit. If you do not have your insurance card with you we may request payment in full at the time of service. In addition to your insurance card, please bring a photo I.D. (drivers license) which will be copied and placed in your chart. Please be sure to inform our office of any changes in insurance coverage, address, employment, telephone numbers, etc. All co-payments are due before receiving care of any type.
PLEASE COMPLETE THE ATTACHED PATIENT INFORMATION FORM AND BRING IT WITH YOU ON THE DAY OF YOUR APPOINTMENT. It is your responsibility to know your co-payment, deductible, and/or percentages that have been contracted with your insurance company. Co-payments, deductible, and/or percentages must be paid at time of service. Our contracted billing source will file your claim with the primary insurance carrier and provide a courtesy of filing a secondary claim.
Many insurance plans require a referral from your primary care physician requesting us to render care. Please obtain the referral from your doctor prior to your appointment in order to avoid assuming total responsibility for your bill.
REFUND / RETURNED CHECKS / BILLING:
We will refund credit amounts under $25.00 upon request only.
There will be a $25.00 charge for all returned checks.
Ultimately, payment for services provided to you is your responsibility. Payment is due upon receipt of a statement. We contract with an ‘outside' billing service, therefore, questions about your account and/or insurance should be directed to Rx Physician Services @ 502-896-6926.
In rare and extreme circumstances it may become necessary to terminate a patient from the practice "for cause", and we reserve that right.
Again, thank you for choosing our practice and I want to assure you that I will provide the best care possible with your best interest in mind at all times. I look forward to caring for you.