PRECISION ORTHOPAEDIC SPECIALTIES, INC. 

Help Us to Help You 

As part of the on-going effort of Precision Orthopaedic Specialties, Inc. (“POSI”) to effectively serve and communicate with our patients, the following information is being provided to you to help us serve you better.

Our goal is to make your appointments with POSI effective, efficient and of maximum benefit to you. Please read the enclosed materials carefully and keep this policy for future reference.

PAYMENT FOR SERVICES RENDERED / INSURANCE ISSUES

Your account at POSI is your responsibility. Your medical insurance contract/policy is a contract between YOU and your INSURANCE COMPANY. We will assist you by processing your claims, free of charge, via electronic claims submission. In order to do this accurately and efficiently, please bring with you all insurance cards and claim information. POSI will provide supporting documentation to your insurance company for questioned or rejected claims.

Co-pays are due at the time service is rendered.

We require all patients at their first appointment to file with our Billing Department a written authorization to bill their credit card (Visa/Mastercard/Discover) for outstanding balances left after insurance claim processing. Two (2) itemized statements documenting all charges and payments received from your insurance company will be mailed to you. If we do not receive payment on your account within seven (7) days after the second itemized statement was mailed to you, the patient responsibility portion of your account will be charged to your credit card. Special circumstances that you feel preclude you from compliance with this policy should be discussed with our Billing Department.

Personal injury and motor vehicle accident patients are responsible for their accounts. It is our policy to bill a patient’s health insurance plan. We do not accept Letters of Protection from attorneys. We will provide status of your condition to your legal representative upon your written request. You must sign an Authorization for Release of Medical Information form prior to the release of such information.

Work related injuries are not billed to a patient’s health insurance plan. Work related injuries are billed to either your employer’s Worker’s Compensation Managed Care Organization or their Self-Insured Fund. All injured workers are required to complete a First Report of Injury at our office on their initial visit. You are responsible for a $100 fee to convert your claim to a Worker’s Compensation case if you have been seen prior to authorization of your Worker’s Compensation Claim.

Self-Pay patients are required to pay at the time of service, unless other arrangements have been made in advance with our Billing Department.

You, the patient, are responsible for any collection fees, including legal fees and interest that are incurred to collect on the unpaid balance of your account.

TELEPHONE CALLS DURING OFFICE HOURS

Your call is very important to POSI. Please notify the receptionist of the nature of your call so it can be triaged effectively. Calls of a medically urgent/emergent nature take priority and will be returned promptly.

Calls of a non-emergent nature are returned by a medical assistant within twenty-four (24) hours and outside of office hours. If you would like to speak directly to your physician, your call will be returned on the next day he is in the location where you were last seen. Please be aware that this may be up to three (3) days after you call, as our doctors travel to different locations.

When calling, please provide the following information:

• Reason for the call
• If you are currently ill
• Telephone number(s), including area code, where you can be reached.

In order for us to serve you effectively, your chart must be retrieved prior to the telephone consultation to ensure that accurate recommendations are given. All recommendations given are documented in your medical record. Telephone consultations are NOT a covered benefit under most insurance plans and we do not charge for brief consultations.

APPOINTMENT CANCELLATIONS

Your appointment is being saved for you. If you are unable to keep your appointment, we require at least twenty-four (24) hours advance notice of the cancellation so that someone else may use your allotted time slot. If you cancel an appointment less than twenty-four (24) hours before your scheduled appointment time or you do not show for your appointment, you will be charged Twenty-Five Dollars ($25.00). YOUR INSURANCE PLAN WILL NOT COVER THIS COST.

MEDICATIONS

POSI’s prescription policy is as follows:

• Written prescriptions will be provided free of charge.
• It is your responsibility to know what refill medications you need and what format your insurance company requires for the refills of your prescriptions.

Example: 1 month supply with 11 refills, 2 month supply with 6 refills, 3 month supply with 3 refills, etc.

WRITTEN COMMUNICATIONS

MEDICAL RECORDS

If you require a copy of your medical record for any purpose, you are required to submit the request in writing on our Authorization for Release of Medical Information form. You will be charged for most requests. We will inform you of the cost which is based upon the number of pages. POSI follows the Ohio Revised Code guidelines for cost per page. Once we receive payment, we will process your request.

FORMS

Please bring all forms requiring completion to your appointment and present them at the beginning of the appointment. This includes forms for employment, school, camp, sports, therapeutic shoes, disability, etc. You will be required to fill out POSI’s Paperwork Request Release Form. There will be a Five Dollar ($5.00) charge for completion of each request.

We hope that this protocol enables you to better understand our office procedures. We hope that your experience with our office is favorable. Should you have any questions or concerns, please feel free to contact Colleen Curran, our Chief Operating Officer.

If you have any questions about this Notice, please contact our Practice’s Privacy Officer

ACKNOWLEDGEMENT

 I,                                                          , acknowledge that I have received and read

               (Patient Name, Printed)

the POSI Help Us to Help You protocol.  I authorize POSI to:

1. Submit claims directly to my insurance company for services rendered by POSI;
2. Charge my credit card, which I have on file with POSI, for outstanding balances remaining on my account after sixty (60) days from insurance claims processing; and

3. Charge my credit card for any interest or late fees due and owing on my account.

Signature:                                                            Date: