MISSED APPOINTMENT/ NO SHOW/LATE APPOINTMENT
Please call to cancel your appointment at least 24 hours prior to the scheduled time, to allow us to schedule another patient for that time. Last-minute cancellations (less than 24 hours) and missed appointments, will be considered a no-show. If you do not show up for your first visit to the clinic, we may not accept you as a patient in the future. If you are an established patient, we reserve the right to charge $40 for no-shows. The $40 no-show fee is due prior to your next appt. We also reserve the right to dismiss patients from the practice who do not show up repeatedly. We strive to adhere to time; unfortunately, delays do occur. Arriving late to your appointment creates an inconvenience for the other patient scheduled to be seen after you. Patients arriving 20 minutes after their scheduled appointment time will be asked to reschedule. Late arrivals for sick visits will be worked into the schedule but will have to wait for the next open slot.
CO-PAYMENTS/CO-INSURANCE/DEDUCTIBLE
Co-insurance and co-payments are the patient's responsibility. Co-pays are due at the time of the visit. Deductibles are the patient's responsibility. The deductible is determined by the contract you have with your insurance carrier. We do not know how much each person's deductible is and how much has been met at the time of your visit
INSURANCE COVERAGE/INSURANCE CHANGES
It is your responsibility to be aware of your insurance coverage, policy provisions, exclusions, and limitation as well as authorization requirements. This information is furnished by your insurance carrier. We attempt to verify that your coverage is valid at the time of your visit. However, if your coverage is not in effect at the time of your visit, the financial responsibility for payment is yours. If you have had any changes in your insurance coverage; Even if there is only a small change in the co-payment amount or a change in the expiration date of the policy *you must notify us. Even a small discrepancy on the chain form can lead to a claim denial.
NON-COVERED SERVICES/ INSURANCE REQUEST/CONTACT
All patients are responsible for "non-covered" services if denied by their insurance carrier.
You are responsible for responding to any request from the insurance company for further information. Not doing so will result in claim denial and you will be responsible for payment.
INSURANCE PAYMENT SENT TO YOU
If insurance payments are sent to you, you are responsible for forwarding them to our office with a copy of the Explanation of Benefits (EOB) received.
LAB SERVICES
All sent-out-lab services are billed by Quest Diagnostics or Health Track COVID-199 PCR). If your insurance requires a different lab service, it is the patient’s responsibility to notify us at the time of the visit. Allsent-out-labb services will be billed to your insurance company by Quest Diagnostics.
MEDICATION REFILL POLICY
All medication refills for chronic conditions are done during an office visit. We recommend you bring all your medications during your visit. If the patient is due for their follow-up or preventative care, we may need to schedule these visits prior to refilling prescriptions and can address your medication needs at that time. For the safety of our patients, we do not phone in antibiotic prescriptions. If the patient is sick enough to require an antibiotic, we highly encourage him or her to first be examined. We encourage Telemedicine that is offered at our office. *PLEASE ALLOW 1-2 BUSINESS DAYS TO ALLOW FOR PRESCRIPTION CALL-IN. We do not call in controlled substance prescriptions for safety reasons and require office visits for a thorough evaluation. There will not be any prescription refills called in if there are no office visits within the past 3 months.
COPY OF RECORDS/FORMS/LETTERS
Medical forms/records can be lengthy, therefore medical records or forms can take up to 3 weeks to complete. Depending on the type of records, forms, or letters, for each request, there will be a $25.00 fee charge. A charge will be waived, if documentation is completed during the visit. This is an administrative fee for certain forms, letters, and records completed by our office staff. Examples of these forms are; health verification forms, return to work/school letters, disability forms (must-have office visits), and legal forms for the government. This fee is a non-billed/ non-billable service and will not be billed to the insurance company. This is the patient’s responsibility.
TREATMENT FOR CONSENT: Telemedicine and In Office
Telemed
-I understand that if telemed treatment is unsafe for me (or the patient being treated), the provider (Mindy Kang NP), will either ask the patient to come into the office for an evaluation or the Provider (Mindy Kang NP) will discharge me as a patient (or the person being treated) and advised to see a nearby provider/specialist.
In Office Treatment
-I understand that the Provider (Mindy Kang NP ) is a Family Med/General Primary Practitioner, if a health condition(s) can't be managed in the office, please note that the Provider will refer the patient being treated to a specialist(s).