111 Center Pointe Dr 931.648.7615

Policies

PREPARATION FOR ARRIVAL TO APPOINTMENTS

• Arrive 15 minutes prior your appointment time if any insurance or demographic changes need to be updated.
• Bring your insurance cards and picture ID to all appointments.
• Bring your medication list or medications to each appointment so we can update your medication list.
• If you need refills on your medications, please bring list to your follow-up appointment.
• Please remember to bring your co-pay, co-insurance or deductible ($100 +) amount due it will be collected prior to your visit.
• Provider reserves right not to render care to patient if he/she does not sign all our office agreements or make payments.

FINANCIAL RESPONSIBILITY

Payments: Co-Pay, Co-insurance & Deductibles are due before medical services are rendered. We accept Cash, local Checks, American Express, Discover, Mastercard & Visa credit or debit cards.
Late Payments: If payment is not made on the day of visit, a $20 charge will be added to your visit for late fee. Any Outstanding balances are due before additional services are rendered. A charge of $10/visit will be added for any outstanding balances of 60 days or more. We Reserve the right not to render medical services if payment is not made at date of visit or patient has an outstanding unpaid balance.
Unpaid Balances: Unpaid balances will be due and payable before another appointment or medical services will be scheduled or rendered (including medication refills). Balances over 180 days will be subject to be turned over to collections and will result in a discharge from medical practice.

PRESCRIPTIONS

Refill Requests: Please use our PATIENT PORTAL for refill requests.
Please Note: Providers will not prescribe new medications, antibiotics or certain other medications without an appointment. Also, providers will not refill medication prescribed by your specialist.
Maintenance Medications: Please give our office 48 hours (2 business days) notice to call in any refills of maintenance medications. If you will not be out of medications prior to your appointment, it will be refilled during your follow-up appointment for chronic conditions and not earlier.
Limited Supply of Controlled Substance Medications: Providers will only give 30 day supply for any controlled substances including pain, anti-anxiety, sleep, wt. management & etc. A 90-day supply will not be prescribed for any controlled medication and you will have to be seen every 1-3 months if taking any controlled substances. Controlled Substance Agreements will need to be signed annually. Controlled substances will not be sent to mail-order pharmacies.

APPOINTMENT TIMES AND LATE ARRIVAL POLICY

You will receive three automated reminders (email, phone or text) – 1 week, 48 hours and 24 hours prior to your appointment as a COURTESY REMINDER. It is your responsibility to remember and confirm your appointment date and time. Please sign up for the PATIENT PORTAL to see your scheduled appointments. Please try to arrive 10 minutes before your appointment time so we may update your insurance and medical information. If you arrive more than 10 minutes past your appointment time, you may be asked to reschedule your appointment.

NO SHOW APPOINTMENTS / SAME-DAY CANCELLATIONS

If you need to cancel an appointment, kindly give our office no less than 24 business hours of notice. This will allow us to fill the available time with another patient that requires care.
No Show Appointments: If you fail to show up for your scheduled appointment our No Show policy is as follows:
• 1st No Show – Reminder Letter & $20.00 charge
• 2nd No Show – Reminder Letter & $40.00 charge
• 3rd No Show - $40 charge and discharge from practice
If you CALL WITHIN 2 HOURS PRIOR to your appointment or AFTER your appointment time to reschedule/cancel it is considered a “NO SHOW” appointment.
Same-Day Cancellations: If you call to cancel or reschedule your appointment the day of the appointment it is considered a Same Day Cancellation. Four Same Day Cancellations, may result in a discharge from the practice.

MEDICAL RECORDS REQUEST

All request for transfer or copy of medical records may take up to 14 business days. Fee for Records - $20.00 (copying charge).

ADMINISTRATIVE MEDICAL PAPERWORK

This includes insurance forms, medication benefit forms, disability form/letters, FMLA, ETC.
• Fee for Medical Paperwork/Review of Records for Letters - $50 and up (up to $200/hr)
• Any forms/letters requiring record review may take up to 14 business days to complete. (If you bring in paperwork and need within 5 business days the fee will be $80 and up)
• A Disability, SS Disability paperwork/letter may require a self-pay appointment.

WORKERS' COMPENSATION AND AUTO INJURY CLAIMS

We do not file Workers’ compensation and Auto injury claims. You will be required to pay the full cost of any auto injury visits. Invoice will be provided for you to submit to the third party agency. We do not provide treatment for workers’ compensation injuries. If you do not disclose that the injury occurred at work when you call to schedule an appointment, you will be responsible for the full cost of a visit for that time slot.