OFFICE POLICIES & PROCEDURES FOR PATIENTS 

Effective, Monday November 26, 2018, Conner Family Health Clinic, will inforce the outlined Office Policies and Procedures below. Your initials and signature, as a valued patient of Conner Family Health Clinic, is your agreement of the following policies, terms and conditions. Failure to comply with the following policies and procedures could result in patient discharge from Conner Family Health Clinic.

In order to better serve our patients in the best way possible, we cannot do it alone, we need your help. Your health is our priority and it should be yours as well. Conner Family Health Clinic schedules patients by appointment only and reserves space for daily same day visits on a need by need basis. In order to accommodate same day/next day visits at our office, we ask that you be mindful of your responsibilities as a patient. It is your duty to plan ahead when it comes to medication refills, follow-ups and work schedules. Same day appointments will be triaged by a nurse and forwarded to Dr. Conner for approval. Medication refills and follow-up appointments are not considered urgent. Calls received in the morning will be reviewed and scheduled in the afternoon if approved by Dr. Conner. Calls received in the afternoon will be scheduled the following day business day.

Arrange to arrive 10 15 minutes prior to your scheduled appointment. Patients are given a 10 minute grace period to arrive to scheduled appointments. Patients who have arrived on time for their appointment will be seen ahead of those who arrive late. If you arrive late, we may need to abbreviate or reschedule your visit depending on the schedule.

Conner Family Health Clinic has a $25 "No-Show" Fee. A No-Show fee will be assessed and your appointment will be rescheduled if you arrive 21 minutes past your appointment time. A $25 "No-Show" fee will also be accessed for failure to communicate, cancel or reschedule within 24 hours ofthe scheduled appointment. After the third no-show, it will be at the physician's discretion as to whether a discharge letter will be sent out disengaging you from the practice. This means you will no longer be able to schedule appointments in our office. No-Show fees must be paid prior to scheduling another appointment. Front office staff may exercise limited discretion in assigning "no shows" to account for special circumstances, such as hospitalization or another emergency.

We will not be able to see a patient for a scheduled appointment if you do not pay your Copay, this is non-negotiable. The contract between patient and insurance requires that each patient pay their copay at the time of service. There is no copay for Annual Wellness Exams (physicals); however, if you present with medical symptoms or chronic health issues that need to be addressed in conjunction with your wellness exam, we will bill your insurance company a separate office visit for those other issues. This is offered as a convenience for you, saving you the time of having to come in for an additional visit. This may result in a charge being passed back to you for the additional visit, in that case an invoice for your copay and visit will be mailed to you for payment. If you have a deductible of $6,000 or more, Conner Family Health Clinic will require a $75.00 deposit prior to seeing Dr. Conner.

To help expedite your visit, avoid billing errors and prevent nonpayment for services rendered at this clinic. It is your responsibility to verify before your appointment with Dr. Conner that he is in network with your insurance carrier. WE DO NOT АССЕРТ BCBS - BLUE LOCAL or MEDICAID. Patients are responsible to update their insurance information with the receptionist at check-in and provide their current insurance card(s). In the event, the patient fails to update staff on new insurance information, Conner Family Health Clinic will bill the patient for any services denied by the insurance carrier we have on file. For patients with Medicaid as a supplemental insurance used to cover the remaining balances from your primary insurance, you will be responsible for the balance not paid since we are not in network, in some cases it may be the full cost of services rendered. Failure to communicate, resolve or to pay any outstanding invoices will result in referral to collections.

Depending on the plan you have you may have a deductible. This is the amount of money you have agreed to pay BEFORE your insurance plan with begin to pay. After each visit we will submit your visit information to your insurance. If you have a remaining deductible, you will receive an invoice from our billing office. Our billing office will send out a maximum of 2 invoices before we send your balance to collections. You may pay balances at the time of your visit, by mail or over the phone. Please communicate with us. We have options available to those who need it. Patients with balances over $300 or that are in collections will not be seen unless a payment or an arrangement have been made. For additional billing inquiries please contact JMK Billing at (980)258-8657.

It is good practice to request medications a least 1 - 2 weeks prior to running out, allowing you time to request your medications and obtaining an appointment if necessary. Please call your pharmacy and have them request your medications via fax or electronically. Allow 24-48 hours to receive medication requests. Note: If requests are made at the end of business, the 24 - 48 hours will begin the next business day. Medications prescribed by other providers will not be filled by Dr. Conner unless an agreement has been made between Dr. Conner and you during a visit.

Controlled substances will not be filled without a visit. FMLA forms and other forms that require questions to be answered require a patient to be seen for a visit. Work excuses/school excuses will not be given without a visit. Patients whom Dr. Conner feels are not stable may require frequent follow-ups to adjust medications and additional testing. Dr. Conner may refuse to fill certain medications if he feels a patient's health is at risk without further observation or is non-compliant.

In an effort to work efficiently with our Laboratory vendors, patients who knowingly need lab work should schedule appointments on Tuesday & Fridays between 8:30am - 12:30pm. However, if during a scheduled visit, a patient will need lab work outside of these laboratory times, we have staff available to accommodate them during regular business hours.

Any forms or specialty letters such as CMS sports physicals, work physicals, FMLA, Immigration, Disability, Counseling etc, that require completion by Dr. Conner or any of the Conner Family Health Clinic staff, may not be done the same day- unless you have an appointment. It is in your best interest to plan ahead and allow ample time tot complete your request. Note: There is a cost associated with this service and some forms may require additional information not available at the time of service. Be prepared to pay a minimum of $35 and a maximum of $150, depending on the form.

Medical record requests can be faxed to 704-708-4389. We will need a signed medical release consent form allowing us to release the patient's information to the desired facility. A turnaround time of 3-5 days is needed in order to complete certain requests. Certain fees may apply and are in accordance with North Carolinas statute § 90-411, medical record copy fees.