NOTICE OF PRIVACY PRACTICES
We keep a record of health care services we provide you. We will not disclose your records to others unless you direct us to do so or unless the law authorizes or compels us to do so. You may get more information by contacting our Medical Records Department. I hereby acknowledge that I have received a copy of Physicians Quality Care's HIPAA Notice of Privacy Practices.
BILLING/FINANCIAL POLICY
Our office is committed to providing quality and cost-effective healthcare to our patients. It is your responsibility as the patient and/or guarantor to know and understand what services are covered by your insurance and obtain all authorizations prior to your appointment. Your provider may recommend services that he/she feels are beneficial but may not be covered by your insurance. It is your responsibility to provide us with your most current billing information as well as your most current insurance information. Insurance reimbursement is a contract between you and your insurance company. As a courtesy to you, we file all claims for you. You will be responsible for all copays, deductibles, co-insurance amounts along with the entire amount of any non-covered services. Payment for your copay or deductible will be required prior to being seen by one of our physicians. Any additional balance will be billed to the address given at the time of check in. If you have any questions or wish to dispute any balance, it is your responsibility to contact our billing office within thirty {30) days after the receipt of the initial statement. Balances not paid in full with thirty (30) days of the statement issue date are deemed past due. If you are not able to pay the balance in full, you must contact our billing office to set up payment arrangements. If your account is deemed past due and/or regular monthly payments are not being made on the account, we may refer your account to Fox Collection Agency. Once referred to Fox, you will be responsible for any collection fees, attorney fees, court costs, etc. Once your account has been turned over to Collections, Physicians Quality Care reserves the right to deny treatment for you or anyone under your care until the balance is paid in full
SELF PAY POLICY
Patients who do not have insurance coverage (or proof of insurance) or who choose to pay for non-covered services are required to pay a $125 deposit at the time of service. This is not the cost of the office visit, but only a deposit. If any additional charges are incurred, they will be billed to the patient at a 25% discounted rate. Due to government regulations, it is considered fraudulent for us to accept payment from TennCare recipients for medical expenses.