Your First Appointment

We will mail you a "Welcome package" with instructions and forms for your office visit. Please bring these forms, insurance card(s) and copies of past urologic work-ups to the office. Also, please be prepared to share your medical history with our physicians. This will include any medical conditions you have or may have had in the past, surgical history, any prescription or over-the-counter medications you are currently taking (include name, dosage and frequency), and any allergies you have to medications or foods.

If a delay in the appointment schedule is anticipated, office personnel will make every attempt to call and notify you. We appreciate the value of your time. Our appointment system is designed to minimize waiting for you.

If you are unable to keep an appointment, please let us know as soon as possible. This courtesy makes it possible for another patient to use your appointment time.

During office hours, call the office, identify yourself and explain the nature of the emergency to the receptionist. The message will be relayed to the doctor immediately. For emergencies during the evenings, weekends or on holidays, again, call the office. Our phones are answered by an exchange 24 hours a day. They will contact a doctor immediately by pager.

Our doctors prefer to use the NORTHEAST BAPTIST HOSPITAL Emergency Room or the NORTH CENTRAL BAPTIST HOSPITAL Emergency Room for any emergencies.

Our doctors return telephone calls as time permits or the situation demands. Please give all the necessary details concerning your problem to the receptionists. In this manner, your problems can be relayed intelligently and quickly to the doctor for a prompt response. Sometimes calls are returned at the end of the morning or afternoon schedule. Every call is returned on the day it is received.

Many questions arise that can be handled over the telephone. Doctors prefer to hear about a problem early, before it develops into a major crisis. Nevertheless, an ill patient needs to be seen by the doctor. It is not our office policy to treat illness over the telephone.

Please call during office hours only for prescription refills so that your chart can be reviewed.

Statements are mailed monthly. Payment is due upon receipt of the statement, unless other arrangements have been made. Payments can be made by mail with check or money order; or with cash or credit cards. If you have any questions about your bill, please let our office know. A monthly payment plan can be discussed if you have financial difficulties. Nevertheless, timely payments are expected to keep the account current. We are members of the local credit bureau and names will be turned over if the account is not paid within the arranged time thereby affecting your credit rating adversely.

Most insurance plans are accepted. Please contact our office to verify if physician is participating in your particular network.

There are many types of health insurance policies available. These policies vary in their coverage. Too often, health insurance is purchased under the mistaken assumption that it will cover medical, surgical and hospital costs in full. Whatever your insurance coverage, you are ultimately responsible for payment of all charges for services rendered. Your insurance policy is a contract between the insurance company and you. This office, the hospital, the radiologists, and the laboratories are not part of that contract.

Insurance companies determine their payments based on information they purchase or accumulate concerning doctor's fees in a geographical region. We cannot predict how much your particular insurance company will pay for services we provide. If you have any questions about your bill, please contact the office manager. Our foremost concern is good service.

If your insurance policy has a pre-certification/authorization requirement, YOU ARE responsible for making our office staff aware of this.

Patients who belong to a Health Maintenance Organization "HMO," and/or "PPO," must provide this office with the required referral and authorization forms from their PCP (Primary Care Physician), before seeing our doctors.

Patients who are covered by the Medicaid Program must inform this office at time of registration and present a written referral from the PCP with a valid "Medical Care Identification Card."

Medicare

We are participating physicians and accept Medicare assignment on all our services. Medicare's regulations require that we must inform you in advance if we believe a service may not be covered because Medicare may determine the service to be "not reasonable and necessary," or "experimental." We, therefore, have to ask Medicare patients to sign a "Waiver of Liability," making the patient responsible for payment if Medicare disallows charges.

Medicare supplemental insurance policies cover the difference between approved charges and the Medicare payment. A claim for the difference can be filed only after Medicare payment has been received. This will be done automatically by our office.

CHAMPUS/Tricare

We are Committed Participating Providers for the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). The patient is responsible for the annual deductible and co-Insurance. The patient is also responsible for providing the office with a Non-Availability Statement when one is required.

Fees charged in the office are comparable to those charged by other urologists in this area. Please feel free to discuss our fees with any of us. We want our care to be affordable.

Patients requiring special laboratory tests and X-Rays will be referred to appropriate laboratories. These laboratories will bill for their services independently.

We appreciate our patients being prepared to pay for office services at the time of the visit. The billing and collection process is otherwise expensive. By keeping these costs down, we are able to maintain reasonable office fees. We accept VISA/MASTERCARD, Discover and American Express and encourage the use of these credit cards.

Our billing system is computerized and we will file claims for all services.

An estimate of the charge for any surgery will be given upon request. It may be impossible to quote an exact figure because of unforeseen circumstances or complications.

Major surgery frequently requires an assistant. Charges for the assistant surgeon will be submitted independently from those of the surgeon.

Surgery usually requires an anesthesiologist (physician trained to administer anesthesia). Anesthesia services will be scheduled at the time surgery arrangements are made. The anesthesiologist will submit charges for his services independently from those of the surgeon. Only medical doctors are utilized for our patient's anesthesia.

Hospitalized patients will also receive independent bills from the hospital, the hospital radiologist if X-Rays are made, and the hospital-based pathologist if laboratory work is performed.

The multitude of charges from different sources after major surgery or hospitalization can be confusing. Our office personnel are available to try to explain them to you as needed.

• Baptist Health System
• Methodist Hospital System
• Christus Santa Rosa Health Care System

Notice of Privacy Practices for Northside Urology Associates
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.