Statement of Practice Policies
General Consent to Treat:
You consent to reasonable and necessary medical examinations, testing, and treatment by AHS physicians and other providers. You are aware that the practice of medicine (including surgery) is not an exact science, and no one has made any guarantees about the results of your treatments, examinations, or procedures. You may be asked to sign other informed consent forms for specific surgeries or procedures.
Patient Rights and Responsibilities:
At AHS, we are committed to optimizing your experience as our patient. We have established the following rights and responsibilities to outline the collaborative effort between patient and physician in a mutually respective relationship.
As an AHS patient, you have the right:
To courtesy, respect, dignity, and timely, responsive attention to your needs.
To receive information from your providers necessary for informed consent, including the specific procedure/treatment, significant medical risks, and probable duration of recovery.
To have the opportunity to discuss the benefits, risks, and costs of appropriate treatment alternatives, including the risks, benefits, and costs of declining treatment or non-compliance with treatment.
To be provided, to the degree known, with complete information concerning the diagnosis, treatment and prognosis of your illness or ailment, and to have the appropriate assessment and management of pain.
To ask questions about your health status or recommended treatment when you do not fully understand what has been described, and to have all your questions answered to the extent possible.
To make decisions about the care the physician recommends and to have those decisions respected, except when medically contraindicated. A patient who has decision-making capacity may accept or refuse any recommended medical or surgical intervention.
To continuity of care, including that your physician will cooperate in coordinating medically indicated care with other health care professionals, and that the physician will not discontinue treating you when further treatment is medically indicated except as permitted under Florida law.
To know the names and professional status of individuals providing service to you and to know the physician primarily responsible for your care.
To have the physician and other staff respect your privacy and confidentiality and to expect that all disclosures, communications, and records are treated confidentially in accordance with applicable law.
To obtain copies or summaries of your medical records and to have the information explained or interpreted as necessary, except when restricted by law.
To obtain a second opinion and to be informed of your right to change providers, if other physicians are available to meet your needs.
To be advised of any conflicts of interest your physician may have in respect to your care.
To be provided with methods of effective communication.
To receive services without regard to race, color, age, gender, sexual orientation, religion, marital status, handicap, national origin, or sponsor.
To be provided reasonable physical access to our facilities and to be provided with a safe environment.
To receive services in a language you understand and in a culturally sensitive way.
To be informed as to key information and policies, including those addressing treatment for unaccompanied minors, expected conduct and responsibilities of patients, services offered, information on after hours and emergency care, fees for services, payment responsibilities, right to refuse participation in research studies or clinical trials, how to file a complaint or express a grievance without retaliation, and ownership disclosure.
As an AHS patient, you have the following responsibilities:
To demonstrate behavior that shows respect and consideration for other patients, family, visitors, all health care personnel, and property of AHS facilities.
To provide accurate and complete information about your medical conditions, health history, demographics, and insurance information, and to provide updates when this information changes.
To ask questions and seek clarification until you fully understand.
To accept the consequences of your actions if you should refuse a treatment or procedure, or if you do not follow the plan of care given to you by the physician or other health care providers.
To keep appointments, cancel appointments, and notify AHS of any changes.
To assure that the financial obligations for health care rendered are paid.
To be responsible for your valuables that you bring AHS facilities.
To provide positive and negative feedback in a constructive and appropriate manner about the care you have received at AHS.
To follow the policies, rules, regulations, and procedures of AHS.
If you fail to follow medical instructions, display disruptive behavior, or have others accompanying you who display disruptive behavior, we may terminate the patient/provider relationship.
If you cancel or do not show for 3 scheduled appointments or fail to remain current on your payments, we may terminate the patient/provider relationship.
Insurance Plan General Information
Every health insurance plan is different, and your financial obligations will vary based on your specific plan. You are responsible for your premium, along with any cost-sharing your plan requires. Co-pays, deductibles, and co-insurance payments are all agreed-upon, shared costs. When you sign up for a health insurance plan, you should understand what your co-pay, co-insurance and deductible will be from the beginning. Additionally, some medical services may not be covered by your plan. If you obtain services that are not covered by your plan, you will be financially responsible for those services. In general, you should make sure to familiarize yourself with the benefits provisions, exclusions, and limitations of your plan before you seek any healthcare services whatsoever, so you don’t incur unnecessary or unexpected expenses.
Cost-sharing is a percentage of charges (for healthcare services provided) that you are responsible to pay, regardless of whether you go to an in-network or out-of-network provider. For example, it is very common for health insurance plans to have “80/20 Coverage,” which means that they will cover 80% of the charges, and you (the patient) will have to pay 20% of the charges (your coinsurance). A patient who has a plan with a 20% co-insurance will pay 20% of the costs of care out-of-pocket after they have paid their deductible, if there is one. To verify the cost-sharing you will have for specific services, check your Schedule of Benefits for details, or you may contact your health insurance company for assistance (phone number can be found on your insurance card).
At AHS, our providers are out-of-network with most insurance plans. What does this mean?
Health insurance companies are cutting their costs by paying providers less and raising deductibles on patients, increasing the burden on consumers, thus increasing their profits. In a PPO, the consumer basically has an arrangement that allows the insurance company to pay their own determination of the “Maximum Allowable Charge” or a percentage thereof. The insurance companies are selling “in-network” hospitals, while often NOT negotiating with physicians who staff those hospitals. Allowing insurers to unilaterally determine “allowable” reimbursement lacks transparency, encourages manipulation, and is not based on the costs of providing care by the physicians.
For the insurance companies to make the most money, they leverage their size and influence to convince physicians and other providers to agree to accept a significantly discounted rate for covered services under their health plan for the “privilege” of being a member of their network. These healthcare providers that perform services for a vastly discounted rate are considered “in-network.” The “in-network” providers hope to make up the difference for the discounted rate by capturing the potential large volume of patients that the insurance company purportedly provides by “participating” in their “network.”
For the healthcare providers that are very specialized, as we are, the portion of the population we treat is narrow, and therefore the volume of patients is comparatively small, as opposed to a primary care practice for example. It is consequently of no benefit for us to “participate” in an insurance company “network” and accept the greatly reduced reimbursement they offer.
We would not be able to offer the same exemplary and higher quality care for the negligible contracted payment we would receive from the insurance company.
Also, keep in mind that for many insurance plans, certain services require prior approval, regardless of the benefit plan you have. We will verify that information for you and obtain that approval/authorization on your behalf.
Your Insurance, Co-Payment, and Co-Insurance:
As noted above a co-payment, or co-pay, is a fixed amount established by an insurance plan for sharing the cost of certain health services rendered by providers who participate with that insurance plan. AHS providers are not participating providers (out-of-network) with most insurance plans. If we do not have a contract with the insurance company, there are no copay requirements with AHS. You will still be responsible for your cost-share and deductible responsibility, as you would be with any in-network provider.
It is your responsibility to understand your coverage guidelines, including out-of-network benefits and corresponding co-insurance obligations for a healthcare provider or surgical facility.
Some things you should know:
If we do accept your insurance plan and your plan requires a co-pay, it is the routine policy for all providers to collect the co-pay at the time of service. If you do not make payment of your co-pay, you will be in violation of the contract that you have with your insurance company. AHS reserves the right to reschedule your appointment if you are unable to pay your co-pay at the time of your visit.
If AHS does not participate with your insurance company, you will be seen on an out-of-network basis and no co-pay is required. You will be responsible only for the stated consultation fee.
Patient Financial Agreement:
You consent to AHS billing your insurance company, Medicare, Medicaid, Tricare, or any other third-party payer (each a “Payer” and together, “Payers”), as applicable, directly for services rendered by AHS and its providers. You further consent to the payment of medical benefits by your Payer to AHS and associated medical providers. We will assist you, but if we cannot secure all necessary prior approvals, authorizations and referrals as required by your Payer(s), you understand that it is ultimately your responsibility to do so.
You agree it is your responsibility to provide AHS with the correct billing information. You hereby authorize AHS to release any health information to all applicable Payers and appropriate third parties, as determined by AHS for eligibility and payment purposes. This release will be considered valid until revoked by you in writing. You authorize any holder of medical or other information about you to release to Medicare and its agents any information needed to determine available insurance benefits.
If you have any financial responsibility (a deductible or co-insurance), AHS will require payment prior to service.
You agree that you are financially responsible for all charges made to your account whether or not a Payer is involved with payment. If you are using your insurance plan, you are responsible for all co-payments (if in-network), and you are responsible for all co-insurance amounts, annual deductible amounts, and any non-covered services or supplies, whether in-network or out-of-network. AHS will file claims with your insurance company as a courtesy to you.
If you have an outstanding balance due, you agree to a prompt payment in full. If you are unable to make payment in full, AHS may, at its sole discretion, consider alternative arrangements for payment. If no payment is received within 30 days, your account may be turned over to a third-party collection vendor and/or a collection attorney. In the event that your account is turned over to a third-party collection vendor and/or a collection attorney, you grant authorization for information to be released regarding your employment status to AHS or to the collection agency and/or collection attorney.
If your account, or that of the individual you are guaranteeing, should be submitted to a collection agency and/or collection attorney for collection, you agree to pay, in addition to all other amounts you owe, any and all costs of collection including, without limitation, reasonable attorney’s fees, and all other costs associated with collection. If any indebtedness is not paid in full within 60 days from the date of service, you agree to pay interest at a rate of 1.5% per month [18% per annum]. All returned checks will incur a returned check fee of $50.00.
If you are without health insurance at the time of service, AHS will offer a self-pay discount to your charge(s). Payment of the reduced amount must be made at the time of service.
We reserve the right to charge a fee for a cancellation of less than 24-hour notice or failure to keep an appointment.
Medication Prescription Policy:
Each prescription will be for a fixed amount of medication (a limited supply will be issued for a short duration). You should take the medication exactly as prescribed. Medication will not be increased or renewed unless deemed appropriate by the provider.
AHS is required by law to participate with the State of Florida E-FORCSE® (Electronic-Florida Online Reporting of Controlled Substance Evaluation Program), also known as the Prescription Drug Monitoring Program, and we are required to access the Florida E-FORCSE® database when prescribing all controlled substances. Florida PDMP/ E-FORCSE® was created by the 2009 Florida Legislature in an initiative to encourage safer prescribing of controlled substances and to reduce drug abuse and diversion within the state of Florida. Controlled substance dispensing information is submitted to the database by pharmacies and made available for consultation by prescribers.
Each prescriber and pharmacy, or his or her designee, is required to consult the PDMP system to review a patient’s controlled substance dispensing history each and every time a controlled substance is prescribed or dispensed to a patient aged 16 or older. Failure to consult the PDMP can result in a citation by the regulatory board.
If prescription pain medication is being obtained or requested from another provider outside of AHS, you will not be able to request or obtain those prescriptions from our providers, nor will a pharmacy be able to dispense the medication to you.
There are limitations and side effects of pain medications including but not limited to sedation, dizziness, drowsiness, nausea, vomiting, constipation, physical dependence, tolerance, respiratory depression, overdose, and even death. Please consult your pharmacist or the warnings supplied by your pharmacy with your prescription.
With regard to the medications you take regularly, you must obtain prescriptions for these medications from your primary care provider. In the interest of your physical well-being, it is strongly recommended that you be under the care of a primary care physician. Our providers do not provide prescriptions for these medications, and do not provide long-term medication management.
Electronic Health Record and Patient Portal Acknowledgement:
AHS uses an EHR (electronic health record) to store and maintain patient health information. We use or HIPAA compliant software to store and access your health information, including but not limited to your office notes, any testing or imaging, patient records supplied by our patients or outside facilities, and a record of your encounters. You authorize AHS to use the EHR (electronic health record) to electronically send and receive PHI (protected health information) pertinent to your care.
AHS offers a Patient Portal called "OnPatient" to its patients, where they can access certain health information about themselves, request appointments, and send communications to AHS staff and providers. If you choose to enroll in the OnPatient portal, you give AHS permission to send your health information through the OnPatient portal for your personal access and use, including but not limited to, messaging, images, and other health documents. Uses and disclosures of information in the OnPatient portal by AHS are governed by this Notice and federal and state privacy laws. If you wish to terminate access to your OnPatient portal, you can contact AHS by sending a message via OnPatient, an email, or a letter.
AHS collects email addresses from our patients if they choose to provide them to us. We use email to send appointment reminders, surveys, and notifications to you about our practice. If you subscribe to the OnPatient portal, you will receive notification emails for activation, appointment reminders, and payment purposes. We consider your email address to be a part of your protected health information. You are not required to provide us with your email address; however, it will limit our ability to communicate with you. If you provide us with your email and later decide you would like to unsubscribe, you may let us know by sending a message via OnPatient, an email, or a letter, and we will remove your email address from our electronic health record.
Our policies require us to email health information to you encrypted or via OnPatient. If you tell us that you want to receive unencrypted email, that email will not be secure. Unsecure emails may be potentially viewable by others. You must provide us with a statement in writing (e.g., via OnPatient, an email, or a letter,) that you do not want email with your health information to be encrypted. You understand that if you ask us to send an unsecured email, you are assuming this risk.
Telephone Calls and Text Messages:
AHS collects residential and cellular telephone numbers provided to us and may use these numbers to communicate with you about your treatment, your appointments, your procedures, or to service your account. We may also leave a message on voicemail in reference to any items that assist the practice in carrying out treatment, payment, or our internal operations, such as appointment reminders, insurance items, and any call pertaining to your clinical care (such as laboratory or testing results).
We do not generally text patients about their personal health information for security reasons. Certain text messages contain minimal information and may be sent using pre-recorded/artificial text messages and/or use of any automatic dialing device. For example, we may text you automated appointment reminders, prompts to sign up for OnPatient, the availability of test results or availability of a billing statement in the OnPatient Portal. We may text you requests to provide feedback about our services. You agree that AHS may contact you as described above. If you decide you would like to unsubscribe from any automated phone/text messaging, you may let us know by sending a message via OnPatient, an email, or a letter and we will remove you from those features.
Patient Satisfaction and Outcome Surveys:
You agree to receive a patient satisfaction survey after a visit to our office. We encourage you to complete it as we use this feedback to educate our team on how we are doing. You are important to our practice and your feedback will help ensure we continue recognizing areas of opportunity that will improve your overall patient experience with us! You also agree to receive a series of outcomes surveys just before and after surgical procedures. You may receive the survey by mail, email or by text message, as described above. Outcomes data is the cornerstone of assuring that our patients receive quality care. This data allows us to measure our outcomes and contribute to ongoing research, so please complete these surveys. AHS compares your responses anonymously to national databases to benchmark the quality of care we provide. Thank you in advance for taking time to complete the surveys!
Acknowledgement and Acceptance of Policies and Procedures
I acknowledge that I will be asked to agree to the above stated policies and practices of Advanced Hernia Specialists, PA during registration.
If you have any questions about the Statement of Practice Policies, you may contact the Office Manager at your local AHS office.
Changes to this Statement:
AHS reserves the right to update the practice policies contained in this Statement of Practice Policies at any time. AHS will make any revised Statement available on its website and in each office location on or after the effective date of the changes. The updated date below may not be earlier than the date the revised Statement is printed or published.
Updated January 24, 2021