Thank you for choosing us as your healthcare provider. We are committed to providing you with the best possible medical care. Your clear understanding of our practice policies is important to our professional relationship.
- Fees for Services and Payments: Fees are standard and based on the complexity of your visit. Payment in full is expected at the time of service and can be made with cash, money order, Visa, MasterCard, Discover or American Express. This payment will include any unmet deductible, co-insurance, co-payment amount, or non-covered charges from your insurance company. If you do not carry insurance, or if your insurance coverage is currently under a pre-existing condition clause or grace period, payment in full for services rendered will be required.
- Claim Filing: While filing insurance claims is a courtesy that we extend to our patients, all charges are your responsibility from the date services are rendered. Your insurance is a contract between you, your employer and the insurance company, we are not party to that contract. Before your visit, it is your responsibility to contact your insurance company to verify that we are participants in your particular plan and that the services you intend to receive are covered. If prior authorization/referral is required by your insurance carrier, it is your responsibility to obtain this from your primary care physician. Failure to do so may result in denial of your claims and you will be held responsible for all non-covered charges.
Not all services are a covered benefit on all policies, so it is particularly important that you understand the provisions of your individual policy. Each health plan selects certain services that they will not cover; therefore, we cannot guarantee payment of all claims by your insurance carrier. (Examples of non-covered services: contraception, infertility and endometrial ablations. Additionally, some plans do not cover preventative or obstetrical services. Rejection of your claim does not relieve you of your financial responsibility)
*PLEASE NOTE: Each visit is documented in your medical record and a diagnosis is made by the provider. Diagnoses are made based on medical information, not based on coverage by insurance companies. To request a diagnosis change solely for the purpose of securing reimbursement from your insurance carrier is inappropriate and is considered insurance fraud.
- Annual Exams and Problem Visits: Please be aware that an annual well woman exam or preventative visit covers the cost of a breast and pelvic exam along with a pap smear and refill of medications only. Any additional problems addressed, or procedures performed, will be billed to your insurance carrier and may result in additional out of pocket expenses. These additional expenses will be expected at the time of service.
- Lab Charges: Depending on your insurance, you may get a separate bill from the lab facility that performs your labs and/or pathology. These charges will need to be discussed directly with the lab facility as we do not collect nor bill for these services.
- Obstetrics: Unlike other types of services, prenatal care is billed globally and will be billed at the end of your pregnancy, after delivery. Your initial office visit to confirm pregnancy, all labs/ultrasounds/fetal monitoring and problems unrelated to routine OB care, such as colds, are not considered part of this global billing and thus not included in your global OB costs. You will be given an in-depth OB billing policy should your care warrant.
- Surgery: Payment is required in full at least one week prior to the scheduled procedure. Our fees do not include an assistant surgeon if one is needed nor does it include fees for the facility and anesthesia. The amount we pre-collect is subject to change if any additional services are provided at the time of the procedure or billing codes are revised. Our office utilizes Baylor Scott & White of Frisco and Medical City of Frisco. It is your responsibility to make sure the facility your procedure is scheduled with is contracted with your insurance carrier.
- Family Medical Leave Act and Disability Claims: If your employer requires Family Medical Leave Act (FMLA) and/or Disability paperwork to be completed by your provider, we are happy to complete these forms for you; however due to the considerable amount of information required there is a 5-7 day turnaround and a charge of $50 for each set of forms. Payment is required before the completion and submission of the forms to your employer.
- Medical Records: In order to be in compliance with Texas State law and HIPAA regulations, should you need copies of your medical records, we charge the following fee: $25 for the first 20 pages and then $.50 per page thereafter. Our office will have 15 business days in which to copy records before making them available for patient, and these 15 days will commence once payment has been made and a signed records release has been obtained. As always, if another physician requests your medical records and we have obtained a signed release from you, there will be no charge.
- Missed Appointments or Surgical Procedures: If you are unable to keep your scheduled appointment you must provide the office with a 24-hour notice to cancel. If you are unable to keep your scheduled surgery, you must provide the office with a 48-hour notice to cancel. If proper notice is not given, regardless of the circumstance, the following fees will apply:
- $50 for any office visit
- $200 for any surgical procedure
We do not double book, so if you do not show you are disrupting the office schedule and preventing another patient from being seen.
- Collections: Accounts that are not paid with 90 days from the due date will be automatically transferred to our external collection agency (Transworld) and reported to the Credit Bureau. In addition to your outstanding balance, a 50% surcharge or $25 fee (whichever is greater) will be added to cover our costs. Accounts placed with our collection’s agency are also terminated from the practice.
- Privacy: The HIPAA privacy rule requires all covered entities to make available a Notice of Privacy Practices to all individuals who receive the use of their services. A copy of our Notice is available for review in the office and at any time on your patient portal. Frisco Unified Womens Health (dba: Frisco Womens Health) may at its sole discretion, change the terms and conditions of this notice.
- Consent to Treat: You hereby consent to medical treatment, diagnostic procedures and injections by providers and staff of Frisco Unified Womens Health. You understand diagnostic procedures may include, but are not limited to lab tests on blood, urine and tissue. You understand you may be asked to undergo diagnostic radiology procedures including, but not limited to, ultrasound. You understand you have the right to ask questions about your treatment and/or procedures and you agree to notify your provider of any concerns.