Microsoft word - office policy.doc

Phone: 954.472.2201
Fax: 954.472.2501
OFFICE POLICY
Thank you for choosing FEMCARE OB/GYN as your healthcare provider. We will be more than happyto answer any questions or concerns you may have regarding your visit. Listed below are our officepolicies: Office Hours: Our office hours are Monday-Thursday 8:30 A.M. – 4:30 P.M. and Friday 8:30 A.M. –
12:00 P.M.
Telephone Calls: We must screen all calls during office hours while the provider and medical assistant
are seeing patients. If you have an emergency, explain to the operator the type of emergency you have
and a nurse will either pick up your call immediately or call you back within the next few minutes. If we
are unable to take your non-emergent call immediately, leave a message and we will do our best to return
your call as soon as possible.
Well Woman vs. Physical Exam: A well woman exam is when a healthy patient is seen to screen for
various illnesses or diseases and is considered preventive medicine. When a patient comes in to discuss
any complaints or suspected illness or disease this visit will be considered a problem exam. We provide
services for preventive medicine, as well as problem-focused medicine. Some insurance plans cover all
office visits the same no matter what the purpose. Other plans may differentiate coverage between a
problem and preventive care. It is always a good idea for you to check with your insurance carrier to
verify your specific benefits so there are no unanticipated financial costs at the time of your visit. The
insurance company makes the final determination of your eligibility. Payment for services is ultimately
your responsibility.
Appointments: It is our goal to provide services to you in the most comfortable and timely manner
possible. Dr. Bass does not overbook appointments, however some visits may take longer than others and
therefore we may run behind. Your patience is appreciated and you will receive the attention you deserve
when seeing the doctor. If you need to cancel your appointment, we appreciate a 24 hour notice. Minors
cannot be seen without prior written authorization by a parent or legal guardian.
Unfortunately, emergencies do occur which may cause delays in our schedule. We will try to keep youinformed as these arise. If you miss two appointments without notifying us before the appointment time,we reserve the right to dismiss you from the practice.
Children: Children are very special to all of us. However, for their safety and the courtesy of other
patients, we must ask that you keep your children with you at ALL times in our office. Children cannot
be left in the waiting room without adult supervision. Please supervise your children in the examination
room also, to avoid exposure to biohazardous waste. We request that you not bring small children to your
new patient appointment as these can sometimes be lengthy appointments.
Prior Authorization: If your insurance requires a referral, you are responsible for obtaining it. Failure to
do so may result in a lower payment from the insurance company. We will obtain
preauthorization/precertification on your behalf for surgery and certain contraceptive devices and/or
medications.
Laboratory Tests: When you have a pap smear or any type of blood work done we will send the
specimen to an outside lab as directed by your insurance company. Remember that since we do send all
lab specimens to an outside lab, we do not charge for the actual test. The lab will bill you separately ifyour insurance does not cover them.
Referrals: Occasionally the doctor will need to refer you to another specialist. The provider will offer
recommendations based on their experience with the specialist. The specialists we recommend may or
may not be an in-network provider with your insurance carrier. You will need to contact your insurance
carrier to find out if that physician is in-network. If they are not you can (1) choose to see a physician in-
network according to your carrier or (2) see the physician we recommend out-of-network.
Prescription Refills: Please call your pharmacy with your prescription number in hand to initiate a
request for refills from them. These prescription requests will be handled within 48 hours of receipt from
your pharmacy during regular office hours. No routine prescriptions, birth control pills or narcotic pain
medications will be handled after regular office hours or on the weekends.
Filing Claims: Please be sure that we have your current insurance information and inform us of any
updates or changes. If we do not have current information this will delay payment and possibly cause you
to have unexpected expenses including finance charges. You will be asked to fill out a new information
profile each year. The profiles expire one year after being signed. You will also be asked to sign in with
updates to your name, address, and current insurance information each time you are seen in our office.
Please be prepared to show your insurance card and I.D. at each visit.
Disability/Insurance Forms: Disability and Insurance Forms will be completed within 72 hours of
receipt.
Medical Records: All requests must be made in writing. One copy of your medical record will be
provided free of charge to any healthcare provider of your choice. Any additional copies requested will
incur our standard charge, i.e. $1 per page for the first 25 pages, and $0.25 for each additional page.
I have read and understand the Office Policy of FEMCARE OB/GYN.

Source: http://www.drbassobgyn.com/Portals/472/forms/Office%20Policy.pdf