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“Office Policy”

 

We would like to thank you for choosing Advantage Plus Medical Center Practice as your primary care medical provider in Irvine, CA.  We have written this policy to keep you informed of our current office policies. 

 

Office Hours:

Our clinic is open Monday – Friday, 8:00 a.m. – 5:00 p.m.

 

Appointments:

Our office staff works diligently to accommodate your schedule as best we can when offering appointment dates and times.

  • We see patients by appointments.
  • Same day appointments are usually available for urgent or sudden illness.
  • Walk-ins are welcome till 3:00 p.m.
  • We will call and confirm your appointment at least 48 hours prior.
  • Please arrive on time for your appointment.
  • For initial visit, please arrive 30 minutes prior to your appointment to allow time for processing paperwork and verifying eligibility.
  • If you are more than 10 minutes late, your appointment may be rescheduled.
  • Most established patients can expect to follow up every 1-3 months. Follow up appointments are essential to tracking your progress and assessing the adequacy and safety of your treatment program.
  • It is the patient’s responsibility to schedule for the follow-up visit, so it is recommended to schedule your next follow-up appointment before you leave the clinic.
  • Current laws and regulations require an office visit every 3 months in order to refill some prescriptions so please do not wait until you run out as most prescriptions require doctor’s approval

 

After Hours and Emergencies:

  • For a life threatening emergency call 911 right away.
  • After hours you will reach our answering service or be directed to the voicemail which will page the provider on call.
  • For urgent matters, please leave a brief message clearly stating your name, date of birth and phone number and our physician will call you within 24 hours.

 

Answered by the voicemail:

Please leave a detailed message-including your full name, date of birth and phone number.  Please allow 24-48 hours for returning your call.

 

Urgent Need or Sudden Illness:

We have a limited number of same day or “work-in” appointments available every day.  Please call early in the day, as these spots fill up quickly.

 

Running on time:

  • We know your time is valuable; thus if we experience an emergency situation, you will be notified. If you prefer to reschedule your appointment, we will schedule you to our first opening slot.

 

Cancellations:

  • Please call within 24 hours if you are unable to keep your scheduled appointment to avoid a cancellation charge.
  • This allows us to provide your cancelled appointment slot to another patient.

 

Lab Work:

  • Blood work we do in our office is drawn by our phlebotomist or medical assistants.
  • Lab work will be send out to the lab contracted with your insurance.
  • If you want to be referred to an outside collection lab, make sure you tell us every time.

 

Labs Ordered by Other Physicians: 

  • We do not routinely draw lab work which has been ordered by other physicians.
  • However, we will fulfill this request if you are here for an appointment.
  • If another physician wants blood tests, but cannot draw them in his/her office, please ask that physician for a lab request form to take to contracted lab with your insurance.

 

Complete Physical Exams:

  • We believe that routine, annual complete physical exams with screening lab tests and procedures are very important to the maintenance of good health. Thus, annual physical is required by most insurance companies and has to be done within the first 120 days from the day of enrollment.
  • However, not allow tests and procedures are covered by your insurance. Please consult with our front office staff to verify your benefits.

 

Medical Records:

  • We will provide you a copy of your medical records upon request for an admin fee.
  • You will need to sign the “Medical Records Release” form prior to having them copied.
  • Please allow 10-14 business days for processing the requested documents.

 

Treatment of Minors:

  • Patients under the age of 18 must be accompanied by a responsible adult.
  • Photo ID of the parent, guardian or conservator is required.

 

Test Results: 

  • If you have diagnostic testing, i.e., lab, x-ray, echo, ultrasound, sleep study, ….etc., please schedule a follow-up appointment within 2 weeks after having the test don to go over the results with your physician and you will be subject to your copay/coinsurance.
  • It is the patient’s responsibility to schedule a follow-up appointment.
  • Results will NOT be given over the phone.

 

Prescriptions and Refills:  

  • If you need to call for refills, don’t wait until you have run out. Most refills require the doctor’s approval.
  • Please call your pharmacy 3-5 business days before you run out of medication and ask them to contact us if no refill available.
  • Refill requests called to us before 2:00 p.m. will be handled by the end of the day.
  • After 2:00 p.m., it may be the next morning before your request can be addressed.
  • Some medications have potential side effects that must be monitored. We require check-ups every 3 months for these medications accordingly with the doctor advice.  Be sure to keep those follow-up appointments. This is to ensure that medications are used safely and effectively.
  • It is the patient’s responsibility to schedule a follow-up appointment.
  • Some prescriptions cannot be called in and must be printed for you to pick up.
  • Don’t call after hours for prescription refills. There is no access to your chart and we may not be able to help you.

 

Samples: 

  • We sometimes offer you samples.
  • Remember that samples are not a long term way to fill your prescription.
  • We do not always have samples of your medications. Please do not rely on samples for medications you take long term.

 

Narcotics: 

  • We do not prescribe narcotics for chronic use.
  • We do not call in narcotics after hours.
  • If you require use of narcotics, our physician will refer you to a specialist.

 

Disability, Insurance Forms, Attending Physician Statements, FMLA:

  • There will be a charge for the completion of medical forms or you may be required to schedule an appointment.
  • Payment is due at the time that you drop-in these forms.
  • Please allow 7-10 business days for the completion of these forms.
  • If you would like the forms mailed to you or to the insurance, please inform the front office staff.

 

Referrals: 

  • Urgent referrals could be done on the same day as your appointment and sometimes it could take 2-3 business depending on your insurance and/or the urgency of your situation.
  • Non- urgent referrals; please allow 7-10 business days for the processing time.
  • Most insurance companies mail out the approval letter within 10-14 business days, otherwise you should receive a call from our office when the referral authorization is obtained.
  • If you did not hear back from your insurance company within 10-14 business days, please call our referral department.
  • As a patient, if you prefer a specific specialist, please note that it is your responsibility to ensure that your specialist is on your plan.
  • Please understand that it can sometimes take a few weeks to get an appointment with a specialist. This is not something we have control over.

 

Dismissal: 

  • If you are “dismissed” from the practice; it means you can no longer schedule appointments, get medication refills or consider us to be you provider. You have to contact your insurance in order to find another provider.
  • Dismissal Process: We will send a letter to your last known address, via certified mail, notifying you that you are being dismissed. If you have a medical emergency within 30 days of the date on this letter, we will see you.  After that, you must find another provider.  We will forward a copy of your medical record to your new provider after you sign a release form.
  • Common Reasons for Dismissal
  • Failure to keep appointments, frequent no-shows
  • Noncompliance, which means you won’t follow physician instructions about an important health issue.
  • Abusive to staff
  • Failure to pay your bill

 

Liability Injury:

  • If your injury is a result from another party’s negligence, please make sure to provide our office with the claim information, if claimed is filed with the responsible party, so we can process your claim.
  • If no claim filed, you are required to pay for services and then collect from the responsible party. We will not file a claim with your insurance but will provide you with a receipt to do so.

 

Worker’s Compensation:

  • If your injury is due to an accident in your work place, please inform the front office staff immediately. We are not authorized to treat you for this type of claim unless a written authorization to treat is authorized from your employer/ employer’s insurance carrier.
  • You will need to contact your supervisor for instructions on how to file a worker’s compensation claim. We regret any inconvenience this may cause.

 

No Insurance:

  • All payments are due at the time of service.
  • Payment is expected as services are rendered unless prior financial agreements have been made.
  • If you are unable to pay your balance in full, you will need to make prior arrangements with our accounting department.

 

Insurance:

  • Although we are contracted with several insurance companies, it is your responsibility to make sure that our physician is in your plan.
  • It is also your responsibility to know your insurance benefits.
  • We do not file secondary insurance except for Medicare Recipients. In order to do this, we will require information from you.  We will need all your demographic and insurance information prior to your appointment.
  • We will also request an update on this information every visit thereafter.
  • We ask that at the time of your appointment you bring your insurance card and a photo ID as well as any other forms that will assist in making sure that your claim is filed correctly.
  • At the time of service, you will be responsible for all fees that are not covered by your insurance, including co-pays, co-insurance, deductibles and non-covered services or items received.
  • The co-pay cannot be waived by our practice, as it is a requirement placed on you by your insurance carrier.
  • We strive to be as accurate as possible in calculating your responsibility but, with so many variations in policies and fee schedules, we are not always exact. You may receive a statement from our office for any balance due.
  • For your convenience we accept cash, credit cards (Visa, MasterCard, and Discover), and money orders. Payments are also accepted by phone.
  • Please bring your insurance card on every visit.

 

Billing:

  • If you receive a bill from us, it is because the balance is your responsibility.
  • Please contact your insurance company first, if you think there is a problem.
  • If you have any questions about your bill, please call our billing department immediately.
  • If you cannot pay your entire balance, please call our billing department to make payment arrangements.
  • If you are unable to meet your financial obligation or have question regarding your bill, please call our Billing Department.

 

Collections: 

  • If your balance becomes 30 days old, your balance will be directed to a collection agency and you may be subject to dismissal from the practice.