NO SHOW/MISSED APPOINTMENT POLICY
When a scheduled appointment cannot be kept, you must call our office at least 24 hrs prior to the appointment time to cancel. Any scheduled time slot held for you cannot be given to another patient in need unless we are notified that you would not be able to make your appointment.
Our fees are listed below:
Late Fee (more than 15 minutes late) - $30 (effective July 1, 2023)
No Show Fee - $40 (Established Patient Appointments that are not Physical/Well Woman Appointments)
No Show Fee - $60 (Physical/Well Woman Appointments)
No Show Fee - $60 (New Patient Appointments)
No Show Fee - $20 (Nurse Only Appointments)
RELEASE OF INFO POLICY
I authorize Horizon Medical Associates to release any results and medical information requested electronically via email, text and/or electronic fax using the information I provide to them.
INSURANCE FORMULARY
In the management of your medical conditions, only medications that do not require prior authorization by your insurance company will be prescribed. The heavy administrative burden required to honor these requests cannot be handled by the practice. Additionally, medications prescribed are ultimately up to the prescribing physician who considers standard of care and patient safety.
If you have two insurances, it is your responsibility to let us know which is primary for timely submission of your claim. Note that incorrect insurance info provided could result in a denied claim and costs to you based on complexity/duration of your visit.
DISMISSAL
At our practice, we are dedicated to providing the best care to all our patients.
However, we do reserve the right to dismiss any patient who does not comply with our office policies.
Upon dismissal and in some cases, family members of the dismissed patient may also be dismissed if deemed necessary to enforce a no contact policy.
COMMUNICATION COMPLIANCE
We would like to offer our patients the opportunity to use convenient forms of communication with their permission. At times, there is a need to retrieve or send medical information pertinent to your care. These forms of communication may be intercepted, altered, or used without detection or authorization.
If you answered no, this means that you are willing to receive this information via secured email, secured text, fax OR collect paperwork in person which may incur additional fees.
By signing below, I acknowledge and accept the terms and conditions of the policies above for Horizon Medical Associates. I understand that I can view the extended policies on www.hmaaustell.com/policies
(serves as signature)
