Policy

 OFFICE POLICY (updated 11/24/16)

PAYMENTS & INSURANCE:

We bill participating insurance companies as a courtesy to you. YOU ARE EXPECTED TO PAY YOUR DEDUCTIBLES, COINSURANCES AND COPAYMENTS for participating insurance companies. We accept cash, personal checks (in-state only). We do not accept credit cards. There is a charge of $35 for returned checks. For patients that cannot pay copay at the time of visit and request copays bills to be mailed there is a billing charge of $5. Patients with an outstanding balance 60 days of more overdue must make arrangements for payment prior to scheduling appointments. If we have not received payment from your insurance company within 45 days of the date of service, you will be expected to pay the balance in full. You are responsible for payment of all charges whether by you or by your insurance carrier. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT OUR OFFICE HAS UP TO DATE ADDRESS AND INSURANCE INFORMATION.

PRIOR AUTHORIZATIONS, REFERRALS & ORDERS FOR TESTS::

Our office will spend appropriate amount of time and resources necessary for referrals and prior authorizations that are deemed MEDICALLY NECESSARY. We do not perform referrals or prior authorizations based on patient preference alone, or for over-the-counter medications that do not require a prescription. WE RESERVE THE RIGHT TO REFUSE TO PERFORM REFERRALS OR PRIOR AUTHORIZATIONS THAT ARE NOT MEDICALLY NECESSARY OR REQUIRE EXCESSIVE AMOUNT OF TIME AND RESOURCES FROM OUR OFFICE. We will not change diagnosis codes to modify insurance coverage (this is illegal and fraudulent). Certain prior authorizations also require a recent office visit to assess continuing need.

Office visit is required for evaluation for NEW REFERRALS and orders for tests. For CONTINUING REFERRALS patients need to be seen in our office within 3 months We will make referrals and orders for tests that are MEDICALLY NECESSARY. We do not make referrals or orders for tests based on patient preference alone. Once a referral is made, ORDERS OR PRIOR AUTHORIZATIONS FOR TESTS RECOMMENDED BY THE SPECIALIST NEEDS TO COME FROM THE SPECIALIST’S OFFICE. When a referral or an order is made you will have to call to make an appointment. We have no control over appointment schedules of ordered tests or specialist office visits and we do not make phone calls to a specialist office for appointments on behalf of the patient. When multiple specialists available, we ask that the patient review the list of specialists and let us know – we will be happy to make the referral as long as it is medically necessary. We work with specialists from Northshore & Advocate Health Systems. We refer to in-network specialists and facilities only. We do not refer to out of network specialists and facilities.

PHONE CALLS & PRESCRIPTION REFILLS:

Routine phone calls, e-messages and prescription refill requests will be addressed within 24 HOURS. If you call with urgent symptoms or cannot be evaluated in our office immediately, we reserve the right to direct you the nearest emergency room or a walk-in clinic. For medical matters of moderate complexity we ask that you make an appointment for office visit. Prescriptions for controlled substances require office visits and cannot be e-prescribed or faxed.

MEDICAL FORMS:

Certain forms (including FMLA, short-term disability, sick leave, return to work, school or work physicals) require an office visit. If you had recently been to the office, you may still be required to come in for a separate visit if the prior visit was not specifically for the medical issues on the form.

COMMUNICATIONS

Communication with our patients is important to us. We try our best to get in touch with you regarding test results and reminders however please understand that because of HIPAA regulations we cannot leave sensitive medication information on voice mails. We ask that you use our patient portal system which is available to all patients for free. It is a secure and reliable way to communicate with our office. If you choose not to use the portal and we re unable to reach you in person by phone, after three documented attempts we will mail you a letter.