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Patient Registration Forms For your convenience, you may print and complete these prior to your visit:
About Our Practice Thank you for scheduling an appointment with Marsh Dermatology. We are committed to your treatment and well being and will work hard to serve your needs. In order to make your visit as pleasant and productive as possible, please review our office and financial policies, which we require you read and sign prior to receiving any treatment. For these reasons we ask you to:
Appointments
Appointments may be scheduled by calling 847-362-7373. The receptionist will gather information to ensure enough time is allocated for your visit. Please arrive for your scheduled appointment on time. Patients who arrive more than 15 minutes after their scheduled time will be worked into the schedule and seen as soon as possible; but there may be a lengthy wait. If you are unable to keep an appointment please call us at least 24 hours in advance so we may use those times for other patients.
Office Hours
On days of inclement weather please call the office before leaving for your appointment to hear a recorded message concerning whether the office will be closed or opening late. Urgent Needs
We will always give urgent needs a priority. Please call 847-362-7373 to determine when we will be available for you. We ask for your understanding when, on occasion, we run behind schedule in order to accommodate others who may have such a need. Should a true emergency arise, call 911.
Prescriptions and Refills
Prescriptions and refills are only issued during regular office hours before 4:00 PM. Calls received after 4:00 PM for routine refills will be handled the next business day. Pain medications are not refilled after hours. We want to process requests for prescription refills as quickly as possible. When a prescription needs to be refilled, please call the pharmacist to check and see if there are refills authorized. If there are no refills, call our office. We may call in a refill or request that the patient first be seen by Dr. Marsh. When you call for refills please have the following information available: patient’s name, address, birth date, medication name, the pharmacy name and phone number. Please contact the office before any medication has completely run out.
Fees, Payment Policy and Insurance
For each visit to our office, we will ask you to provide the information needed to verify your insurance coverage and file your insurance claim. If you are unable to provide adequate insurance information, we will require that you pay in full for services rendered at the time of the visit. Deductibles, coinsurance, and co-payments are due at the time that medical services are rendered.
Marsh Dermatology accepts cash, personal checks, debit cards, Visa, and MasterCard. The office will not accept post-dated checks. There is a $30 charge for all returned checks and you will then be asked to pay cash or money order for all future appointments. Delinquent accounts will be charged a $10.00 late fee. Our office will file for payment with your insurance carrier. Because your insurance policy is a contract between you and your insurance company, it is your responsibility to know and understand your plan’s requirements and policies regarding co-payments, co-insurance, deductibles, and benefits. Should your insurance carrier deny a claim, we will make a reasonable attempt to help you resolve the disputed issues. In the event your health plan determines a service to be “not covered”; you will be responsible for the complete charge. In that event we will bill you, and payment is due upon receipt of the statement. Please keep copies of all billing information so that you can follow-up with claims with your insurance company if it becomes necessary. If your insurance carrier has not paid in FULL within 45 days the balance due may become your responsibility. If an overpayment occurs, your account will be credited, you may either leave that amount on your account as a credit or request a refund providing there is no outstanding balance owed on your account. Please allow 10-14 business days for refunds to be processed and mailed to you. Usual and Customary Rates
Our practice is committed to providing the best treatment for our patients, and we charge what is usual and customary for our area. These rates are established by government regulation and insurance market standards.
Minor Patients
A parent or guardian must accompany a patient under the age of 18 and are responsible for consent of treatment and full payment. Unaccompanied minors will not be treated unless permission is explicitly granted on our Minor Patient Registration Form.
Medical Records
A signed authorization is needed to release medical records. Please allow 72 hours to process medical record requests.
Good medical care results from mutual understanding, respect, and trust. Our goal is to provide you with the highest quality care possible. Should you have any questions, comments, or suggestions on how we may improve our service, please let us know. |
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