Office and Financial Policies

Office Policy
Confirmation of Appointments

Confirmation of your appointment is mandatory. Initial calls are made by our automated system and/or sent to you as an email reminder (if you have provided your address to us) three days in advance. If you are unavailable to respond, call the office to confirm. Complete Exam appointments not confirmed by 3p.m. the day before will be cancelled and the patient will need to reschedule as soon as possible.

Arriving for your Appointment

New patients should plan on arriving 30 minutes before your scheduled appointment. Established patients should arrive 15 minutes before. All patients will need to update and verify demographic and insurance information. Valid state identification is also required. These tasks need to be completed before your appointment to ensure you are seen on time. Arriving late for your appointment affects every patient seen by our provider after your appointment. Therefore, patients arriving late may have a delay in being seen or will be rescheduled.

No Show and Cancellation Policy

Established patients who cancel their appointment without 24 hour notice or do not show can expect a fee of $50.00 for office calls and $75.00 for physicals and special procedures charged to their account. New patients who cancel their appointment without 24 hour notice or do not show will have a $125 fee for physicals and $75 fee for office calls assessed. Our office needs at least this amount of time to fill your time slot with another patient who needs that valued time with their provider. This fee will need to be paid before your next appointment can be scheduled. We understand there may be extenuating circumstances. Please call the office as soon as possible. Be advised that multiple no shows may lead to dismissal from the practice.

Referrals

PMA will process referrals generated by your provider for our patients except for Psychology, Psychiatry and Detoxification programs. PMA is not responsible for patients who schedule their own appointments without obtaining a referral from us.

Forms

A fee of $15 per form is due when brought in or sent to the office for completion outside a scheduled appointment. Your form will not be completed until payment is made. Allow 10 business days for completion.

Patient Compliancy

The practice reserves the right to discontinue the physician/patient relationship due to patient non­ compliance regarding medical and/or office policies. This includes, but not limited to, excessive no shows, not returning phone calls to the practice for appointments or continued rescheduling of such appointments. Please note that once a patient is discharged from the practice, our office policy reads we do not reinstate a patient back into the practice.

As a reminder, our patients are expected to be seen at regular intervals, especially when on maintenance medications. These intervals will be determined by your primary provider.

Patient disrespect to staff or providers is not tolerated and will result in the discontinuation of the physician/patient relationship.

Prescription Refills

All patients are expected to call their pharmacy of choice when in need of medication refills. Your pharmacy will electronically send an e-script to your provider for your refills. All controlled substance refills are to be filled only during a face to face visit with one of our providers, for each refill. (please see our controlled substance policy agreement)

As a reminder, our patients are expected to be seen at regular intervals, especially when on maintenance medications.These intervals will be determined by your primary provider.

Release of Records

We require a HIPAA compliant records release to be completed and signed by the patient in order to obtain or forward records to a previous or new provider of care. When sending records to a new provider, a charge of .75 cents per page will be billed to you.

Financial Policy

It is the patient’s responsibility to ensure that we participate with their insurance carrier prior an appointment. Since each insurance carrier has multiple plans that can vary with employer group contracts,we cannot always tell you in advance whether your charges will be covered. Any remaining balance is the patient’s responsibility.

You must present your insurance card(s) at every visit. Failure to present correct insurance information within 60 days will result in patient responsibility for charges. Your copay, deductible and co-insurance balances are due at time of service. Failure to pay at time of visit will result in an additional fee of $20 added to your account.

Self-Pay Patients

Self-pay patients are required to set up payment arrangements with the Billing Dept. staff prior to your appointment.

Statements

You will receive a statement for any balance due after your insurance carrier pays. If 60 days have lapsed without payment, a $50.00 administrative fee will be added and your account will be referred to our Collection Agency. If you have not contacted our Billing Department within 60 days of being referred to our collection agency, you will be discharged from the practice. Please note that once a patient is discharged from the practice, our office policy reads we do not reinstate a patient back into the practice.

In consideration of financial hardship situations, we require contact with our Billing Department to establish a payment plan within 30 days. You will be given a contract to sign explaining our payment plan options.