Southern Tier Medical PLLC
  • Home
  • Notice of Privacy Practices
New Patients:
• Bring copies of all your imaging reports (x-ray, MRI, CT scan etc.) to the first visit.
• Bring all insurance cards.
• Bring all necessary paperwork sent to you ahead of time, filled out completely.
• For No Fault and Workers Compensation cases, you will also be asked for: date of accident, name and address of insurance carrier, claim number, policy number (if applicable), name and phone number of claim representative, and attorney contact information. Please make sure you have up-to-date information. 

Office Policies:
• Please arrive for appointments on time. If you are more than 15 minutes late, you may have to reschedule, or wait until an opening is available (at the provider’s discretion.) If you are unable to keep an appointment, please contact our office 24 hours in advance. 

• Follow all treatment plans, including scheduled appointments, procedures, physical or occupational therapy.

• Bring your insurance card(s) to every visit.

• Have a Primary Care Provider. If you change your PCP, please inform our staff. If you need a referral to a new PCP let us know. 

• NO-SHOW POLICY/CANCELLATIONS: To cancel an appointment, please call the office 24 hours PRIOR to the appointment. Patients who fail to keep a new patient appointment without calling to reschedule will not then be rescheduled. Existing patients who:
  •  miss 3 or more appointments in a 6-month time frame (including same-day cancellations)
  •  “no show” a procedure
  • repeatedly reschedule appointments,
may be discharged from the practice for non-compliance with care plan.  

• If your appointment is after telephone hours, staff will be on site to assist you. 

• Inappropriate conduct including foul language or mistreatment of staff members is grounds for immediate and permanent discharge from our practice

Financial Policies:
• BILLING: We participate with many insurance carriers. Please remember, ultimately patients are responsible for providing accurate billing information at every appointment and determining whether our services are covered by your insurance contract.

• REFERRALS AND CO-PAYMENTS: lf your insurance requires a referral, it is your responsibility to obtain a valid referral at the time of treatment.  You are always responsible for applicable co-payments and deductibles as determined by your insurance company. Self-pay patients are expected to pay on the day of service.

• Co-payments, deductibles, and co-insurance are payable at the time of service. If you are unsure of your insurance coverage, please contact your insurance carrier(s). 

• PATIENT BALANCES: If your account is over 90 days past due, we may refer your account to a collection agency, and you will be responsible for any and all costs associated with collection including, but not limited to, reasonable attorneys’ fees. Nonpayment of balances may result in discharge from this practice. If this occurs, you will be notified in writing that you have 30 days to find alternative care. During that 30-day period, we will be able to treat you on an emergency basis only. 

• OTHER INSURANCE: lf we do not participate with your insurance, you are responsible for payment in full at the time of your visit. Our office will bill your insurance carrier on your behalf. If the claim fails to pay our office in 60 days or there is no response from the insurance company, the balance will be transferred to patient responsibility. You will receive a statement in the mail reflecting this.

• WORKERS' COMPENSATION AND MOTOR VEHICLE ACCIDENTS: lf Workers' Compensation or No Fault is your only insurance, you are responsible for providing us with accurate information regarding the date of injury, WCB and Carrier Case numbers, as well as your insurance company's name and address. If your claim is denied, all outstanding balances and future services will be your responsibility unless you have a secondary insurance. In order for our office to bill your private health insurance, all information must be provided at your initial visit to ensure timely filing of your claim.

• FORM COMPLETION: Forms including those for disability applications, FMLA and other benefits can be long and involved, and may require an office visit. We have not historically charged our patients for completion of these forms. However, be advised that ALL forms require 10 business days to process.  We will fax or mail the forms directly to the requesting agency.

• RECORDS REQUESTS: There is an administrative fee of .75 per page for most medical records requests. This fee is not covered by insurance. All requests for medical records are required to be in writing. IMPORTANT: Records requests require 10 business days to process. 

Copyright Billy R. Carstens, D.O. Southern Tier Medical PLLC. All rights reserved.