This facility has on staff a physician assistant (PA) or nurse practitioner (NP) to assist in delivery of medical care. A PA/NP is a graduate of a certified training program and is licensed by the state board. Under the supervision of a physician, a PA/NP can diagnose, treat and monitor common acute and chronic disease, as well as provide health maintenance care. Supervision does not require the constant physical presence of the supervising physician, but rather overseeing the activities of and accepting responsibility for the medical services provided.
It is solely the patient’s responsibility to obtain an initial referral as well as keep up with authorizations for follow up visits. We will obtain any required authorization for tests or procedures that are ordered by our physicians.
Please do not assume your primary care physician or your referring physician has called or faxed the authorization to our office. If an authorization has not been received by our office, you may be asked to sign a waiver accepting financial responsibility for the visit if we are not able to obtain an authorization for the visit.
Payment is expected at the time of your visit for any co-payment/co-insurance
amount, plus any deductible. If you do not have insurance or if your insurance
sends payments directly to you, then payment in full is due at each visit.
For your convenience, we accept Visa, MasterCard, Discover, cash or check.
Should an over-payment occur on the deductible or percentage amounts charged,
we will apply a credit to your account. If you have an appointment within
the next 60 days, the credit is applied to your account and can be used
at that visit. If no further appointments are needed, a refund check for
the credit amount will be mailed to you.
You will also be asked to make a payment on any outstanding balance at
the time of your visit. Patient balances after insurance processing are
due within 30 days.
We have professional billing and patient account representatives available
to answer any questions you may have regarding your account.
NSF (non-sufficient funds) checks are sent to InstaChek for collection.
A service fee of up to $30 is charged on all returned checks in addition
to the amount of the check.
Each patient will be asked to sign a statement of agreement with our Financial
Policy upon arrival in one of our offices.
The Notice of Privacy Rights describes how medical information about you
may be disclosed and how you can get access to this information. As our
patient, under HIPAA (the new federal privacy act), you have specific
privacy rights. We are required by law to provide you a copy of the notice
and obtain your signature verifying that we did so. Each patient will
be given this notice upon arrival in one of our offices, and will be asked
to sign an acknowledgement of receipt.
If you would like to obtain the Privacy Notice and sign the acknowledgement
form prior to your arrival, you may download them both now, read the notice,
print the acknowledgement form, sign it, and bring it into the office
with you.
Download the Privacy Notice.
Download the Spanish Privacy Notice.
Download free Adobe Reader.