Office Visits

We request that our new patients complete the patient registration forms with information regarding present urologic problem, medical history, current medication and insurance coverage. Periodically you will be asked to update this registration information. This will enable our staff to know and serve you better. We ask that you bring any pertinent records, x-rays, test results, etc. with you to the office visit, as well as your insurance card.

Please sign in at the reception desk upon arrival to our office. You will be seen by appointment and sign-in time. We strive to keep on schedule and apologize when our appointments to see the doctor fall behind due to emergencies and the like. We do our best to accommodate ALL of our patients, and your understanding is greatly appreciated.

Patient Forms

For your convenience, you may print and complete the following forms before your office visit.

• Patient Medical Record Request
• Patient Registration Form

Prescriptions and Refills

Prescriptions and refills are issued during office hours Monday through Thursday, and Friday until 12 noon. Please check your medication and plan accordingly. During non-office hours the physician will not have access to your medical records and therefore will not routinely write a prescription or issue a refill.

When requesting a prescription or refill, it will help us if you have your pharmacist?s phone number and your medication information on hand at the time of your call.

Payment Obligations

Our facility, staff, equipment and supplies are designed to meet your health care needs but they are costly. Please help us contain costs and avoid finance charges by rendering payment promptly at the time of service. Co-pays, deductables, fees for uncovered services, and charges to patients with insurance coverage with whom we do not participate are due the day of your office visit. For your convenience, we do accept Visa, Mastercard, and American Express credit cards, as well as personal checks, and of course, cash.

It is important to us that each patient has a clear understanding of their responsibility to satisfy their financial obligation for services rendered. It is necessary for you to make regular payment on the outstanding balance of your account. We will take action to recover past due accounts when this arrangement is not honored. Overdue balances may be subject to an interest charge.

If you are experiencing financial difficulties, arrangements can be made to set up a monthly payment plan. Any questions regarding our fees or billing statements will be welcomed by our billing coordinator.

Refunds are issued monthly on any account where an overpayment has occurred.

Insurance

For your convenience, our receipts for office visits include all the necessary information your insurance carrier will need to process your claim. If, after you have submitted your claim, additional data is requested, we will assist you in providing the required documentation.

If you are scheduled for surgery, please check with your insurance plan for special requirements regarding second opinion or pre-certification of surgical procedures. Our billing office will submit the necessary claim and paperwork to your insurance carrier for your surgical charges.

Insurance coverage varies greatly from policy to policy, as do co-payments and deductibles. Some policies pay a fixed amount for services and others pay a percentage of the charge. Many insurance carriers use the term "reasonable and customary" to determine the portion of charges that a policy will cover. An individual insurance policy?s reimbursement methodology does not dictate our fee. Our fees are fair and competitive. You are responsible for any unpaid balance on your account.

Medicare & HMO Participation

Our office will submit all claims for services rendered. Our participating status does not dismiss your co-payment responsibility or payment of your deductible, which is due at the time service is rendered. It is each individual patient's responsibility to ensure that any necessary referral is obtained prior to the scheduled visit.

We participate in many health insurance plans, including Medicare and HMOs. Please inquire about your specific carrier. For any questions or concerns regarding insurance, please contact our billing coordinator at 609.924.5534.