PATIENT POLICIES

  ** You are required to attend AT LEAST your annual wellness check/ physical with this office. Failure to do so may result in discharge from the practice.**

** We request the courtesy of 48 hours notice if you have to cancel your appointment. We do understand that unforeseen events do arise and giving 48 hours notice is not always an option. In these situations we ask that you notify as much in advance as possible.**

** If you do not show for a regular appointment, $25 will be charged to your account. The fee for not showing to New Patient visit, Annual physicals, PAP Smear/GYN or a procedure will be $50. THESE FEES ARE NOT BILABLE TO OUR INSURANCE AND MUST BE PAID BEFORE YOUR NEXT VISIT.**

** If you arrive 10 minutes past your appointment, you will be asked to reschedule.**

**IF YOU DO NOT SHOW TO YOUR NEW PATIENT INITIAL APPOINTMENT, YOU MAY BE DISCHARGED FROM THE PRACTICE. AFTER 3 NO SHOWS IN A CALENDER YEAR, YOU MAY BE DISCHARGED FROM THE PRACTICE.** 

  ** You are required to attend AT LEAST your annual wellness check/ physical with this office. Failure to do so may result in discharge from the practice.**

** We request the courtesy of 48 hours notice if you have to cancel your appointment. We do understand that unforeseen events do arise and giving 48 hours notice is not always an option. In these situations we ask that you notify as much in advance as possible.**

** If you do not show for a regular appointment, $25 will be charged to your account. The fee for not showing to New Patient visit, Annual physicals, PAP Smear/GYN or a procedure will be $50. THESE FEES ARE NOT BILABLE TO OUR INSURANCE AND MUST BE PAID BEFORE YOUR NEXT VISIT.**

** If you arrive 10 minutes past your appointment, you will be asked to reschedule.**

**IF YOU DO NOT SHOW TO YOUR NEW PATIENT INITIAL APPOINTMENT, YOU MAY BE DISCHARGED FROM THE PRACTICE. AFTER 3 NO SHOWS IN A CALENDER YEAR, YOU MAY BE DISCHARGED FROM THE PRACTICE.** 

 **We ask that you bring all your medications your are taking or a current list from your pharmacy to all appointments**

**PLEASE NOTE THAT ALL MEDICATION REFILLS REQUESTS MAY TAKE 48 BUSINESS HOURS TO BE PROCESSED**

  **Insurance** We participate with many insurance plans. If you are not insured by a plan by a plan we participate with, payment in full is expected at each visit. If you are insured but don't have an updated insurance card, payment is due for each visit until we can verify your coverage. Knowing your insurance benefits is your responsibility.

**Co-payments and deductibles** All co-payments and deductibles must be paid at time of visit.

**NON-COVERED SERVICES** Please be aware that some, and perhaps all of the services you receive may be noncovered or not considered reasonable or necessary by Medicare or other insurers. You will be responsible for these service in full.

** Proof of insurance** All patients must provide this office with up to date proof of insurance. The office will maintain a copy of your Drivers license or Picture ID and a valid insurance card in your file. Failure to keep updated insurance information will result in you being responsible for all charges not covered.

**Nonpayment** If your account is over 90 days past due, you will receive a letter

stating that you have 30 days to pay your account in full. If you are not on the sliding fee

schedule, a copy of the sliding fee discount program application will be sent with the

notice. Partial payments will not be accepted unless authorized. Please be aware that

balances that remain unpaid, and no attempt has been made to contact this office, a

discharge letter may be mailed and the physician will only be able to treat you on an

emergency basis for thirty (30) days from the date of this letter.