New Patient Forms
Questionnaires
Notice of Privacy Practices
Medical Records Request
New Patient Visits
At the time you schedule your first appointment at Complete Healthcare for Women, you will be requested to bring your insurance card(s) and all of your current medications with you on your first visit. Because you will need to complete our patient registration forms and a brief health history questionnaire, you are requested to arrive at least 30 minutes prior to your first appointment. Alternatively, you may print these forms which can be found in the Patient Resources area of our web site and complete them at your convenience prior to your first visit. These forms include:
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Scheduling
an Appointment
Patients are seen by appointment Monday through
Friday, 9:00 a.m. to 4:30 p.m. Our receptionists are available daily until 5:00
p.m. to assist with your appointment scheduling:
Columbus (614) 882-4343
Unless you have an emergency, it is best to
call in the afternoon when our phones are least busy.
If you are not
able to keep your appointment as scheduled or are going to be late, please contact
our office as soon as possible. This courtesy allows us to be of service to other
patients.
We try our very best to stay on schedule, although emergencies sometimes arise. If we are seriously delayed, we will attempt to notify you as soon as possible. Occasionally, we may call patients in the waiting room out of turn if they have an emergency. We ask for your patience if you have to wait.
Telephone Assistance
To save you
the time and expense of some follow-up visits, we may request that you call us
at the office to report on your condition. Our medical staff will take the information,
review your medical record with the physician and return your call at the end
of the day if it is not an emergency. Should you have questions regarding your
condition, medication or treatment, please call our office during normal business
hours when we have access to your medical records.
If you need to have
your prescription refilled, it is helpful if you know the name and phone number
of your pharmacy. If you have your prescription bottle, it is best to keep it
handy when speaking with our office staff.
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Emergency Care
Should you have an urgent problem, please contact our office
immediately at:
Columbus (614) 882-4343
Our phones are answered 24 hours a day. In a true emergency, it is best to go to the Emergency
Department of the nearest hospital where the physician on duty will initiate treatment
immediately.
Fees
Fees for medical services provided at Complete Healthcare for Women vary and are determined by the complexity of the individual patient's condition. Generally, there are two types of fees, professional and facility.
Professional fees normally
include office visits, consultations, surgery and diagnostic procedures, medication, laboratory tests,
x-ray and ultrasound examinations.
Facility fees include the use of the surgery center, all surgical support staff services, and most supplies
normally used in the specific procedure.
We are pleased that you have chosen Complete Healthcare for Women for your health care needs. As a licensed
ambulatory surgery and diagnostic center, we offer a less costly alternative to typical hospital-based care
in a convenient and comfortable environment. We are concerned about healthcare costs and welcome your comments
and suggestions. Our office has highly trained and qualified personnel available to answer your insurance
questions. Complete Healthcare for Women and its physicians participate in Medicare.
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You and Medicare
As a participating provider for Medicare, we accept
the amount that Medicare allows for covered services. Medicare will generally
pay 80% of this Allowable Charge after you have met your annual deductible. You
are responsible for payment of your deductible and the remaining 20% Medicare
allowance.
The
following example is of a patient that has met the
annual deductible:
Physicians charge ........................................................................................................
Medicare
will allow
.........................................................................................................
Medicare
will pay 80% of their allowance or 80% of $100.00
...............................
Patient
is responsible for the remaining 20% or 20% of
$100.00*.......................
Total
Paid to Physician
.................................................................................................. |
$100.00
$100.00
$ 80.00
$ 20.00
$100.00 |
*This portion of a Physicians charge may be paid by a supplemental policy if the patient carries such insurance.
Most
patients have supplemental policies. Many of these policies pay the remaining
20% of the allowable charge. We understand that there maybe times when finances
can be difficult. If there is a specific problem as to payment, feel free to contact
our business office to make financial arrangements. Please bring your Medicare
card and your supplemental insurance card so that our insurance specialists may
file your claims accurately.
Private Insurance
If you are covered by a private insurance carrier, our staff will contact
your insurance company to determine the extent of your coverage. Private insurance
plans vary and may cover anywhere from zero to 100% of your medical and surgical
charges. Our staff will advise you of your coverage limitations as well as the
charges for which you will be responsible. Patient deductibles and co-payments
are due at the time of service.
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Pre-Certification
Some insurance carriers require pre-certification or second opinions
prior to certain diagnostic or surgical procedures. Our staff will be happy to
assist you. However, you are responsible for making this determination.
Filing Insurance Claims
Our office will gladly file your Medicare, Primary and Secondary insurance claims for you. If you have any questions concerning your coverage or require assistance, please feel free to speak with our business office personnel.
Self
Pay
Patients without insurance coverage will be responsible for
all charges incurred. At the time of service, payment in full is expected and
customary. Should you need financial assistance, we will work with you so that
charges will not be a burden.
Billing
We prefer not to send monthly billing statements due to the cost of paperwork and postage. Therefore, we request that your portion of the payment due to the Urology Center of Florida, be paid at the time of your visit. We accept Medicare and insurance assignments, and we offer several payment options including MasterCard, Visa.
Referrals
If you have been referred to Complete Healthcare for Women by another physician
or have a family physician, please inform us. We will be able to keep your physician
current on your diagnosis and condition.
Confidentiality
Your medical record is strictly private. We will not give out information
regarding your condition to your employer, friends or relatives without your written
authorization. The only exception to this is when required by law. |
