We are committed to providing you with quality medical care. Your clear understanding of our office and financial policy is important to the patient-provider relationship. Due to the costs associated with medical care along with the complexity of health insurance, billing and collections, A Primary Care Clinic for Adults has adopted the following policies.

• Patients are seen by appointment only. Same day appointments are often available for urgent or sudden illness. Please contact the office as early in the day as you can, as these spots fill quickly. If no appointments are available, the details of your health concern will be discussed with the provider to determine a further plan of care. Please do not come to the office to wait for a possible opening. • Appointments which are not cancelled at least 12 hours in advance will be considered a Late Cancel. If you are more than 10 minutes late or do not attended your scheduled appointment, this is a No Show. • Our office policy is to charge a $100.00 fee for a late cancelation or a no show. This fee must be paid prior to any additional appointments and/or medication refills. You will be notified via Square and email.

• If you experience a serious medical emergency please call 911 right away or go to your nearest emergency room. If you are unsure what to do, please contact the office and provide the details of your situation. If it is after hours please text or call the after-hours number and provide detailed information, including your name and phone number.

• Please request medication refills during your appointment. If you need medications refilled between appointments, please contact the office or the pharmacy to request a refill. Refills can be requested no sooner than 28 days after your last refill. • DO NOT wait until you are out of your medication to request a refill. Refills require a provider’s approval and may take 24 hours to process. APCCFA is not responsible for knowing when your medications are due to be refilled.

• If you are to be referred to a specialist it may take 1-2 weeks to find a provider, depending on your insurance and/or the urgency of your situation. We will contact you as soon as the referral &/or authorization is completed. • If you are referred to a specialist and you fail to follow through, no further referrals for that health concern will be completed.

• If you are “dismissed” from the practice it means you can no longer schedule appointments, get medication refills or consider us to be your medical provider. You must transfer your care to another provider. • Common reasons for Dismissal: Frequent late cancels &/or no shows; Noncompliance with treatment; Being abusive toward staff &/or Failure to pay your bill. • We will send a letter to your last known address, via certified mail, notifying you that you are being dismissed. If you have a medical emergency within 30 days of the date of the letter, we are required to see you. However, a medical emergency does not included routine medications. If you take a medication that could physically harm you if stopped abruptly, a 30 day supply of this medication will be provided.

• Patients under the age of 18 must be accompanied by a parent or guardian for their first visit. Future visits must have written permission for treatment from a parent or guardian. This form can be found on our website.

• Patients may request to view their medical records. This will need to be done in the presence of the provider in case you have any questions given the use of medical terminology. You may request a copy of your records by providing a signed release, indicating the requested information. There is a fee for copying medical records which must be paid in advance. If you transfer care, simply sign a release of records with the new provider and they will request the records on your behalf.

• It is your responsibility to notify our office promptly of any changes in your insurance in order to facilitate appropriate billing for the services rendered to you. We must be able to verify your coverage prior to your visit. If we are unable to verify coverage, your appointment may be cancelled or re-scheduled. • We will bill your health insurance company on your behalf, as a courtesy. If you are covered by more than one insurance company, we are required to bill each company. They tend to be aware of dual covered patients and require an EOB from the primary in order for the secondary to pay. • Insurance companies have what they refer to as a Timely Filing Limit. Failure to provide complete and accurate insurance information may result in claims being denied due to exceeding the Timely Filing Limit. If this is the case you will be responsible for all denied charges. • The insurance company makes the final determination of your eligibility and benefits.

• It is important that we have your correct contact information on file. Please advise us anytime there is any change to your address, phone number, email etc. Please submit a new Patient Demographics form online.

• Payment in full is due prior to your appointment. If your payment is not received prior to your visit it will be cancelled. Telehealth visits will be billed via SQUARE the day before or the day of your appointment.

• Insurance payments come with an Explanation of Benefits, which tell us what we can charge you and what we must write-off. Co-pay’s and coinsurance/deductible amounts cannot be waived by the practice for any reason, per our contract with the insurance company. • Account statements are sent monthly through SQUARE and payment is due within 30 days. If you receive a bill and disagree with the amount due, please contact the office immediately to explain. We will check the accuracy and make any adjustments as needed. If after that, you still disagree with your bill, you will need to contact your insurance company.

• Just as we make every effort to accommodate you when you are in need of medical care, we expect you to make every effort to pay your bill promptly. • If you are unable to pay your bill in full contact the office IMMEDIATELY to arrange a payment plan. • If your account balance becomes delinquent (90 days past due) or you fail to adhere to the payment plan, your account may be turned over for further collections actions. • In the event that you are sent to collections, you will no longer be a patient here and must find care somewhere else. • You will also be held liable for any fees associated with collections actions being taken, including but not limited to court fees, attorney fees etc.

• This office uses LabCorp to process samples collected in the office. • LabCorp will bill your insurance and send you a statement for any patient portion owed. • If you have any questions regarding a bill you receive from LabCorp, you must contact them directly. We do not have access to any billing information.