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Insurance and Payment | Prescriptions and Refills Medical Information Release | Hospital Affiliations Our Notice of Privacy Practices describes our legal duties and privacy practices with respect to your personal health information. New patients will be asked to sign an acknowledgment form that you received this Notice.
Patients are seen by appointment only. By contacting our office as far in advance as possible, you allow us to arrange your appointment at the time that is most convenient to your busy schedule. If you find that you are unable to keep your appointment, please notify the office as soon as possible to reschedule at a mutually convenient time. At your initial visit, you may be asked to provide:
For your initial visit, please download, complete and bring in the following forms:
The practice participates with most major insurance carriers. Please call 419-531-7860 to verify that we accept your insurance. If your insurance carrier requires a referral form, you should submit that form before seeing the physician. If our billing office does not have this form, you will be billed for your office visit. Payment is required for office services at the time they are rendered. These should be made at the conclusion of your office visit. Patients who receive insurance through an HMO or PPO contracted with this office are responsible only for co-payments. Patients are financially responsible for medical services rendered regardless of insurance coverage. If your account becomes past due, or if there is an unusual financial situation in your family, which makes paying your medical bills difficulty, please call our insurance secretary at 419-531-7860. Our office initiates collection procedures on all accounts that remain unpaid ninety days beyond the initial billing notice, unless alternate financial arrangements are reached. Your financial questions and concerns will be discussed in a courteous, efficient manner. Please make us aware of any questions or complaints that you may have with reference to our charges, services or office personnel. Our patients' concerns are important to each of us.
It is our policy to write prescriptions and refills during office hours when there is convenient access to your medical records. Please have the following information available when you call:
During evenings and on weekends, it is more difficult to evaluate prescription information. Try to anticipate the need for refilling your medical prescription and contact your physician during regular office hours to discuss medication.
As you know, there is a bond of confidentiality between patient and physician. This may be described as a legal as well as a moral bond, and for these reasons, we have developed the following policy regarding release of medical information to your insurance company and to your attorney:
We often request a urine specimen at the time of your appointment. In anticipation of this, do not urinate prior to your appointment.
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 www.genito-urinary-surgeons.com
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