Updated Office Policies
Updated 8/17/2022
UPDATED OFFICE POLICIES
Northwest Pulmonary and Sleep Medicine is dedicated to your health and medical care. Our goal is to assist our patients with requests in an efficient and timely manner. To support the staffing needed to address the volume of requests and increases in services outside of patient visits, we are implementing new policies effective August 17, 2022.
FORMS/NOTES/ETC
Services such as forms, referrals, notes, or additional questions or queries are included at no additional charge when addressed DURING THE TIME OF AN OFFICE OR TELEVISIT. It is your responsibility to bring paperwork with you at the time of the appointment or get it to us prior to a TELEVISIT.
Due to the volume of requests for services OUTSIDE OF AN OFFICE OR TELEVISIT, we are implementing the following policy:
Referrals, patient forms, or any other additional questions or queries are based on clinical time spent and are charged at $150 per hour, with a minimum of 20 minutes per request ($50). Addressing these questions during your office visit will avoid these charges.
If a specialty pharmacy drug is ordered as part of your treatment plan, a $25 administrative fee will be charged to support the processing of these orders.
These fees are NOT covered by commercial insurance and are the patient’s responsibility.
These charges ARE covered for Medicare patients who are enrolled in Medicare’s Chronic Care Management program with our practice. If you are not enrolled in Chronic Care Management and would like to be, please alert one of our staff during your visit and your provider can implement this for you.
CANCELLATION/NO-SHOW FEES
A cancellation with less than 24 hours notice OR a no-show may result in a $50 fee assessed to your account.
CALLS AND MESSAGES
Please note that non-urgent messages will be addressed within 3 to 5 business days. This includes any test or lab results, equipment requests, refills, billing questions, or routine questions.
Urgent calls (illness or acute symptoms) will be addressed within 24 hours. Please refrain from leaving multiple messages regarding the same issue. Asking for test results, medication refills, prior authorization completion is NOT CONSIDERED URGENT.
MEDICATION ISSUES
Medication Refills:
Refills for controlled substances, such as sleep aids, WILL NOT BE ADDRESSED by the on-call provider. These requests will only be addressed during business hours. Please contact your pharmacy to request refills or make your request through the patient portal.
Medications will not be refilled if you have not been seen by a provider within the last 12 months.
Medication Prior Authorizations:
Some medications require prior authorizations (PAs) per your insurance requirements. There is paperwork required for this and this can take up to 7 days to address.
If your medication is a specialty drug, it may take up to 30 days to obtain a PA or even longer if an appeal is needed if the medication is denied. Please refrain from multiple calls regarding this process.
PAGING ON CALL PROVIDER AFTER HOURS
Any after-hours page to the on-call provider for any reason is subject to a $50 charge which will be billed to your account. If the provider deems the call appropriate, it will be converted to a televisit and billed to your insurance.
ZERO TOLERANCE POLICY
Our staff has the right to work in a safe environment. We do not tolerate verbal abusive or threatening behavior in any capacity. If a staff member is subjected to this in any capacity from a patient or their family member, you will be discharged from the practice immediately and your primary care provider will be notified.
IMAGING INFORMATION FOR NON-MEDICARE PATIENTS
Please read the following information regarding obtaining orders and scheduling CT, MRI, and PET scan imaging:
Due to insurance and document requirement changes, prior to scheduling ordered testing, we need to obtain a prior authorization from your insurance before you can schedule your ordered test.
Once we have contacted your insurance and obtained the prior authorization number, we will notify you and you will be free to schedule your test at that time. This process may take up to 7 days from the date of your appointment. Please do not call us regarding this process unless it has been AFTER 7 days since your test was initially ordered.
PLEASE NOTE IF YOU CHOOSE RAYUS RADIOLOGY (Lake In The Hills), THEY WILL OBTAIN THE PRIOR AUTHORIZATION ORDER FOR YOU AND YOU ARE FREE TO SCHEDULE YOUR TEST RIGHT AWAY. This is often a cheaper alternative to going to a hospital based system.
Insurance / Payment / Billing
At Northwest Pulmonary and Sleep Medicine, we accept Medicare and most major insurance plans. Please contact your insurance company or you may call our office at 8154777350 to find out if we accept your insurance plan. Please be advised that if you are a new patient with commercial insurance and you have not yet met your deductible, you may be assessed a deposit at the time of consult.
If your insurance plan requires you to pay a co-payment, co-insurance, and/or a deductible, you will need to pay at the time of your visit. For your convenience, we accept cash, checks, Visa, and MasterCard. We can also set you up with Care Credit, a credit card that can be used for all health-related expenditures, www.carecredit.com
Outstanding patient balances are expected to be paid in full, or a payment plan set up with our biller, prior to your next scheduled follow-up or CPAP supply shipment.
If you have a question related to your bill or insurance, please call our office and ask to speak to the billing department.
Referrals
If your insurance is an HMO/managed care plan and you are required to obtain a referral from your primary care physician, the referral must be obtained before you can be seen for an office visit.
Please coordinate this with your primary care physician in advance. Appointments will be rescheduled if required referrals are not received in the office by the time of your visit.
