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Terms & Conditions

This document comprises the mutual agreements made between you and Good Health Medical, P.C. dba MY DR NOW.

FINANCIAL POLICY

Co-payments are due at the time of service for office visits including any follow up office visit(s). Co-pays are a contract between you and your insurance company; therefore, MY DR NOW is unable to waive them. Based on standard insurance and clinic guidelines, all payments, co-pays, and outstanding balances are due at the time of service. MY DR NOW accepts all major insurance plans; additional forms of payments include cash, debit cards, MasterCard, Visa, Discover and American Express. As a service to you, MY DR NOW will process an insurance claim on your behalf. Not all insurance plans cover all services. In the event your insurance plan determines a service is not a covered benefit, you will be responsible for the entire charge. Payment for past due patient balances will be collected prior to obtaining additional services. To ensure all billing and financial matters are handled appropriately, MY DR NOW engages a thirdparty agency to review and process all refund requests and therefore cannot issue refunds in the facility under any circumstance.

Self-Pay Patients

For all self-pay patients, payment is due in full at the time of service. This includes payment for any ancillary services including but not limited to labs, x-rays, immunizations, injections or procedures. At any time if you choose to be seen as a self-pay patient, MY DR NOW will not be able to bill your insurance carrier for the cost of the office visit. The self-pay fees are only available for self-pay patients who pay in full at the time of service.

Worker’s Compensation Claims

If the injury is not approved, your insurance cannot be billed, and the services will be your responsibility.

Responsible Party

I have read and understand MY DR NOW’s Patient Policies, and I agree to be bound by its terms. I also understand and agree that such terms may be amended by the practice from time to time. I understand that I am responsible for all charges regardless of insurance coverage.

I agree to pay my account with MY DR NOW in accordance with the standard rates and payment terms of this office. I understand that I have provided all information including accurate and complete insurance information. If I do not provide all necessary information, I understand I will be responsible for all charges incurred for any and all visits at MY DR NOW.

I understand that a monthly late fee of $10 will be assessed for all patient balances over 30 days old. If it is deemed necessary, in the sole discretion of this office, to take collection action as a result of nonpayment, I understand that any collection expenses incurred, including late fees, attorney’s fees and contingency collection fees are my responsibility.

PRIMARY CARE PROVIDER (PCP)

I hereby authorize MY DR NOW to appoint a MY DR NOW provider as my Primary Care Provider (PCP). I hereby opt in to receive communications both related and unrelated to my healthcare in the form of SMS/Text and/or email from MY DR NOW. I understand I may rescind this authorization, or Opt-Out, at any time by submitting written request to Remedy@MYDRNOW.com.

NOTICE OF HEALTH INFORMATION PRACTICES

MY DR NOW participates in a non-profit, non-governmental health information exchange (HIE) called Health Current. This participation will not cost you anything and can help your doctor, healthcare providers, and health plans better coordinate your care by securely sharing your health information. By signing above, you acknowledge that you have received and read the Notice of Health Information Practices. You further understand that your healthcare provider participates in Health Current, Arizona’s health information exchange (HIE) and understand that your health information may be securely shared through the HIE unless you complete and return an Opt Out Form to your healthcare provider. The Opt Out Form is available upon request submitted to Care@MYDRNOW.com.

PATIENT POLICIES

MY DR NOW is your “Medical Home”, where you can be seen for all of your medical needs. Feel free to just walk in or make an appointment in advance. We are here whenever you need us. Providing you with superior healthcare is our number one priority.

Overview

We strive to provide you with all of your Family Practice, Internal Medicine, Pediatric, and Urgent Care needs. However, with certain HMO and Medicaid (AHCCCS) plans, we can only provide services if MY DR NOW is designated as your medical home. In other words, if you have an HMO or Medicaid (AHCCCS) plan, MY DR NOW needs to be designated as your primary care physician’s office in order for you to take advantage of all the services we provide.

Refills & Prescriptions

Medication errors involving prescription drugs account for 1.5 million injuries and deaths per year according to the esteemed Institute of Medicine. Of this number, 400,000 cases of medication errors are preventable. In order to minimize preventable medication errors and provide the highest quality care, medication refills are best addressed at the time of your visit with your provider; please have all of your medications with you at the time of every visit. Once an ailment or disease process is stable or controlled, you may receive a 3 to 6-month supply of medication at your provider’s discretion. Prior to running out, we ask that you meet with your provider for re-evaluation to obtain refills, as they will not be refilled over the phone, by fax, or request from your pharmacy. Refills on antibiotics and narcotics are strictly prohibited. Please note that lost prescriptions will not be refilled and will require a new visit with your provider (this includes self-pay patients). Please also note that the providers at MY DR NOW are unable to see, evaluate, examine, or diagnose patients who are not officially being seen in the clinic, at a House Call visit, or through a Telemedicine visit.

Medical Visits

Based on a report from the National Academy of Sciences’ Institute of Medicine, preventable medical errors cause over 98,000 fatalities each year. As we strive to provide the highest quality care to our patients, MY DR NOW has implemented policies to help ensure optimal care. Therefore, the providers at MY DR NOW cannot treat, evaluate, or change the treatment modalities of anyone who is not officially being seen as a patient. This policy extends to giving medical advice or changing treatment modalities over the phone. We are always happy to serve our patients, so if there are ever any questions or concerns regarding your healthcare, please don’t hesitate to come in for an office visit or schedule a House Call or Telemedicine visit for further evaluation. Clinic policy states that all patients who visit MY DR NOW for any type of care or assistance are required to have a full set of vitals completed at the time of visit. This also applies to House Call visits.

Cancellation Policy

As a courtesy to other patients, we ask that you provide us with at least 24 hour notice if you need to cancel or reschedule your appointment. MY DR NOW reserves the right to charge a $25 fee to all patients who are in violation of this policy.

Co-Pays

All co-pays are due at the time of service; this includes follow-ups, nurse visits and blood draws. All fees, co-pays, and outstanding balances are due at the time of service; failure to collect such balances as a result of oversight or misinformation provided by the payer does not void or negate balances due and may be subject to additional late and collection fees. A $10 convenience fee will be charged for all uncollected co-pays.

Preventative Medicine

Preventative medicine (such as physicals, well woman exams, and well child checks) is the part of medicine engaged with preventing disease rather than treating it. For the sake of thoroughness, during a preventative office visit, the providers at MY DR NOW may defer treatment of other ailments or disease processes for a later visit. If other nonpreventative issues are addressed at the time of a preventative visit, the applicable co-pays will need to be collected prior to completing your visit. Preventative visits are only exempt from co-pays when the focus of the encounter is strictly preventative and does not, in any manner, address non-preventative complaints, concerns, issues, or refills.

Medical Visit Basics

A medical visit is comprised of an evaluation by a trained medical professional. A medical visit in no way guarantees that any form of medication, treatment, referral, diagnostic study, doctor’s excuse, or any other request made by the patient will be granted. It is at the sole discretion of the provider to consider what is most prudent and requests for refunds will not be taken into consideration. MY DR NOW allows for a platform in which patient-provider interactions may occur; differing, conflicting, opposing, contradictory, inaccurate opinions, and/or diagnoses do not negate or void balances due.

Lab & Study Results

In order to minimize miscommunication of study results, details will be addressed with our patients during the time of a medical visit. Specific details of lab and study results will not be discussed over the phone or other electronic communications. In the event of an abnormal result, we ask our patients to complete a medical visit for interpretation of results, further evaluation, and to discuss the abnormal findings and treatment plan with a provider. You will receive notification from our office to provide you with instructions on when you should return. If you have questions or concerns about normal study results, we invite you to schedule a medical visit and have a provider interpret the results and discuss any remaining questions and/or concerns which you may have. There will be a charge for these visits.

Food & Eating

With the exception of bottled water, food is prohibited within our clinical locations.

Referrals & Prior Authorizations

The healthcare industry standard for the processing of referrals and prior authorizations is 14 days. At MY DR NOW, we strive to beat industry standards in every aspect. Please allow 7-14 days for the processing of referrals and prior authorizations. We are our patient’s biggest advocates, and we believe in attacking ailments and disease processes aggressively. The providers and staff at MY DR NOW work diligently to get approval for the studies and referrals we believe our patients need. Sometimes this process may take longer than we like, but please be patient as we work with your insurance company to get you the superior healthcare you deserve. Please also remember we are prohibited from completing referrals and prior authorizations on ailments for which you have never been seen and/or evaluated for here at MY DR NOW.

Phone Messages

A MY DR NOW patient representative may contact you within 24-48 hours of your office visit to ensure that all questions and concerns have been adequately addressed. We encourage and request that our patients ask questions and provide feedback; we also request that our patients contact us anytime they have questions or concerns about their care. Please allow 24-48 hours for a return call from one of our team members when leaving messages. Please also remember that the providers at MY DR NOW are not able to refill medications, give any medical advice, or make changes to any treatment modalities outside of a medical visit. If your needs must be addressed sooner, please feel free to complete a medical visit any time during office hours.

Treatment of Minors

It is generally preferred that a parent or guardian accompany a minor at any visit. There are however exceptions to this rule. Delivery of care will not be delayed while waiting for consent when evaluating a minor with an emergency condition. A minor is also allowed to give consent for the diagnosis and treatment of drug and alcohol related issues, contraceptive services, and for the treatment of sexually transmitted diseases. When appropriate, minor ailments may also be treated without the presence of a parent or guardian. Once again, written or oral consent is preferred, but not mandatory, and this will be left to the discretion of the practice. Sports physicals, however, require written consent when the parent or guardian is unable to accompany the child.

Copies of Records

We are happy to provide you with copies of any and all of your medical records upon your request. We hope that you will be happy to know that we are a paperless office and eliminate waste whenever possible. To aid in this effort, we provide our patients with a personal electronic copy within 3 business days (72 hours) for a fee of $25. A personal electronic copy may be expedited to within one business day (24 hours) for a $50 fee.

Forms & Letters

In order to provide patients with requested forms and letters in a timely manner, a charge to complete each individual and separately identifiable form will be assessed. If a provider must write a letter or fill out forms and documents on behalf of the patient, a flat fee will be required to complete the request. Please allow 3 business days (72 hours) for this process to be completed. All fees are due at the time of request.

Medical & Doctor’s Excuse of Absence

An excuse of absence will be granted by the provider based on medical necessity. If an extension is required for an excuse of absence, the patient will need to be re-evaluated with an additional medical visit. An excuse of absence or an extension for an excuse of absence cannot be granted without an evaluation by a provider during a medical visit.

Pain Management

Pain is costly for individuals and society; an adult experiencing pain loses an average of 23 days of productivity per year. Moreover, pain can significantly affect the quality of life of an individual and cause disruptions in sleep, eating, mobility, and overall functional status. Furthermore, millions of Americans live with pain, and since pain management is an integral and important part of medicine, the providers at MY DR NOW believe acute pain should be managed appropriately. However, in order for our patient population to receive the best care possible, we recommend a pain specialist be utilized for the evaluation, management and treatment of chronic pain. To reiterate, we do not treat chronic pain at MY DR NOW. Acute pain is defined as pain that has a recent onset, has a duration of less than 3 months, and subsides as healing occurs. Chronic pain is defined as pain that persists or progresses over a 3-month period, is often resistant to medical treatments, and may require a consistent dose of medication in order for the patient to remain functional. Please be aware that standard medical protocol states that pain management after surgery is best handled by the surgeon’s office and not a primary care doctor. Some of the medications MY DR NOW does not prescribe include, but are not limited to: Fentanyl, Dilaudid, OxyContin, Oxymorphone, Methadone, and Suboxone.

Disruptive Behavior & the MY DR NOW Code of Conduct

MY DR NOW’s Code of Conduct defines disruptive behavior as anything that an individual might do which may (A) interfere with the orderly conduct of the practice (B) interfere with the ability of others to effectively carry out their duties (C) interfere with patient care (D) undermine a patient’s confidence in the practice or any member of the healthcare team (E) be interpreted as offensive, disrespectful, demeaning, abusive, combative, confrontational, including any behavior and/or language which may be deemed to be inappropriate in any manner. MY DR NOW is fully committed to protecting its staff, providers, and patients against any form of disruptive behavior, and once the cornerstone of the doctor patient relationship is eroded the practice reserves the right to discharge the patient from the permanently. MY DR NOW will aggressively pursue and litigate against any disparaging statements and/or behavior which may be deemed as defamatory, libelous, or slanderous.

Pregnancy Tests

Please note that when urine studies are ordered by a provider, a pregnancy test will automatically be performed on all female patients of childbearing age regardless of past Gynecological, Obstetric, or surgical history.

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