Please take the time to review our policies about clinic appointment cancellations, payment, and protecting your privacy (HIPAA). If you have any questions, please do not hesitate to call us at 210-946-1400. We are always happy to answer any questions that you may have. Thank you. You will be asked to initial each of these policies when you are first seen in our clinic.
We know that life is busy and that patients’ schedules are full. However, we must make you aware of our clinic cancellation policy. It is our goal to see patients in a timely fashion and to ensure that we are able to see patients newly diagnosed with cancer as soon as possible. As such, our scheduled appointments are extremely important and we hope that you are able to come to clinic at your scheduled time. However, we must make you aware that if you fail to cancel your appointment within the 24 hours, you will be considered a “no-show”. Patients who fail to present for two visits in a 12-month period will be considered to be a “chronic no-show”. After two missed appointments, the patient will be sent a bill for $50.00 and a letter asking if another appointment is desired. After the third missed appointment, the patient will be sent another bill for $185.00 and may be discharged from the clinic. The decision to discharge a patient from our practice will be made by the physician.
Thank you for choosing us as your health care provider. We are committed to providing you the highest level of care. The following is a statement of our Financial Policy that we require you to read and sign prior to any treatment.
We are authorized providers under most insurances and Medicare and Medicaid plans. We accept all major credit cards. If you are not covered by any insurance, please do not hesitate to contact our clinic manager, Robert Edwards, RN at 210-946-1400 to discuss this.
If the physician is contracted with your plan, the majority of members covered under this type of plan are still required to make some type of payment for service that is rendered to them. This may be in the form of co-payment, deductible, or co-insurance. If your plan has a co-payment, you will be expected to pay your co-payment prior to being seen by the doctor. Co-payments, deductibles and co-insurance are requirements of your insurance plan and we are required under our contract with these plans to collect these amounts from you.
Most of the members covered under and HMO plans also owe co-payments. Co-payments will be collected prior to being seen by the doctor. We are required under our contract with these plans to collect these amounts from you.
BALANCES ON ACCOUNT
All previous balances are to be paid in full prior to additional services being rendered.
Should it become necessary for us to utilize the services of an outside collection agency in order to collect the amounts that are owed, you will be liable for agency/attorney fees.
ASSIGNMENT OF BENEFITS AND MEDICAL RECORD RELEASE
I hereby authorize my insurance benefits to be paid directly to the above-signed physician realizing I am responsible to pay non-covered services and I hereby authorize the release of pertinent medical information to insurance carriers. Further I understand and acknowledge that I am ultimately responsible for the financial liability of the services provided.
Thank you for reviewing our Financial Policy. Please let us know if you have any questions or concerns.
HIPPA – Protecting Your Privacy