Office Policies
To our patients: All policies set forth below have been set up by our medical providers. If you have any questions or concerns related to these policies, please ask to speak to our Office Manager.
Arrival Time:
Please arrive 15 minutes before your scheduled appointment time to complete or update any necessary paperwork for your visit. You are required to update your demographic and insurance information at each visit. Please present your insurance card to the front office for scanning.
To expedite your check-in process, please visit www.foxmillfp.com to update or complete your personal and insurance information online.
Missed Appointments:
Appointments cancelled with less than 24 hours notice will be charged a fee.
a) sick and routine follow up visits -- $25.00
b) physical appointments, diabetic appointments, or comprehensive follow up visits -- $50.00
Appointment Reminders:
Our practice uses an automated system for appointment reminders. Our system will contact you two days prior to your appointment to confirm the day, date and time of your appointment. You will be prompted to confirm or cancel your appointment. The system will not leave a message if you do not answer. You will not receive any other reminders of your appointment. This is done as a courtesy; you are responsible for any missed appointments.
Forms, Letters and Reports:
The completion of any documentation is subject to a fee. All fees must be paid in full before the forms are processed. Please allow at least 5 business days to process the information.
Sports Physicals (if not done at time of physical) - $20
Fairfax County School Physical Forms (if not done at time of physical) - $20
Medication authorization forms for school (if not done at time of visit) - $20
DMV forms - $20
Adoption Physicals - $25
Family Medical Leave Act - $35
Disability Forms (depending on complexity) - $25 to $ 50
Other forms and Patient letters (depending on complexity) - $20 to $50
Medical Records:
To obtain a copy of your medical records you must sign a release form. All fees must be paid prior to the release of records. Fees are based on Virginia State Guidelines. Medical records will be copied onto a CD. The handling fee is $20. Please allow 7-10 business days to process all requests.
Prescriptions:
Please contact your pharmacy for refill requests. They will fax or email the request to our office. It may take up to 72 hours to process your refill. If you have not been seen in our office in the past 6 months or are prescribed certain medications for chronic conditions, you must come in to be re-evaluated by the provider to obtain your refill.
Referrals:
We require 72 hours to process referrals due to increased requests. Referral requests will not be back dated.
On Call:
Phone calls after hours are for urgent matters only. Providers on call do not refill medications nor call in medications, including antibiotics or narcotics.
Verbal Abuse:
Verbal abuse regarding missed appointments or any other office policies may result in dismissal from the practice.
Laboratory tests and billing:
We have a representative from Quest Diagnostics in our office. Quest is not a part of Fox Mill Family Practice; Quest is here as a convenience so you will not have to go to a separate drawing station. You may use any other laboratory facilities if you choose.
It is your responsibility to supply the phlebotomist with your insurance information. For any billing questions, please contact Quest, not our billing department. Our billers do not have access to the lab billing procedures or charges.
Workman’s Compensation and Auto Accident claims:
We are not contracted with any third party carriers. It is your responsibility to pay at the time service is rendered. Most carriers do not permit us to file if you are involved in an accident. These injuries are handled through different insurance carriers. We will supply you with the necessary encounter form and any office notes needed for you to file for reimbursement.
Patient Financial Responsibility:
Patients are responsible for knowledge of their insurance benefits as well as being fully responsible for all charges regardless of insurance coverage. If you do not believe your insurance will cover a procedure, you have the right to decline the procedure prior to it being performed. It is your responsibility to determine whether we participate with your insurance carrier prior to your office visit. The insurance policy is an agreement between you and your insurance company. You must provide the front office staff with a current insurance card. We will not contact the insurance carrier to verify if you have coverage if you do not have a card. We will only submit charges on your behalf to insurance carriers with whom we participate. If your insurance company does not pay within 60 days, you will be responsible for payment in full at that time.
Co-payments and Coinsurance:
Where we have participating agreements with insurance carriers, your co-payment and/or coinsurance is due at the time of your office visit. Failure to make your co-payment will result in an additional $10.00 service charge for administrative costs.
No Insurance or Non-Participating Insurance:
Payment is due in full at the time of your office visit. If you do not have a current insurance card, you will be considered a cash account. Payment will be due at the time of your visit. If you have recently lost your coverage, contact the billing department prior to your appointment. We can set up a payment plan.
Returned Check Fee:
There is a service charge of $35.00 for each check returned for insufficient funds. Your account may be subject to payment by cash and credit card only.
What about billing problems?
Please contact our billing department at (703) 476-1050 (prompt 9) between 9 am and 4:30 pm daily. A representative should return your call within 24 hours. Most problems occur when the insurance information was not updated at the time of your office visit. You must update your information in writing as well as supply our front office with a copy of the front and back of your insurance card. We have 60 days to file the initial claim. We are not responsible for contacting the insurance carrier to verify if you have coverage.
10/19/09