Transparent Fees

Insurance companies have complete control over payments and dictate the time allotted for your visit. To keep our practice running smoothly, we ask that you adhere to the following guidelines concerning your appointments and appointment times.

Most appointments are 15 minutes long. So that other patients may keep their scheduled appointment time, we would appreciate you keeping your issues to one major or one minor problem during your appointment. This will allow our clinicians to devote their attention to the issue that concerns them the most while minimizing the wait time for other patients. We will do our best to accommodate your needs and help with any issues that run past the 15 minutes.

If all of your issues or questions aren’t resolved during the 15-minute appointment, please make a follow-up appointment to address those issues.

Physical Examinations require 20-30 minutes and focus on identifying any major issues. If you have major medical issues that need to be addressed, we ask that you make a separate appointment.

Diagnosis

• Keep a written list of all of your symptoms and problems.

• Document your health history (current medications, allergies, past illnesses, past medical treatments, and family health conditions).

• Ask questions about your diagnosis. Be sure you understand what the doctor says. Ask for an explanation of any terms you do not understand.

• Be sure you know the instructions for any medication, whether a generic version of the drug is available, and what the possible side effects are.

• Ask what treatment you should follow, including medical treatment and dietary and lifestyle changes.

Testing

• If you need tests, ask how much the tests cost and whether your insurance will cover them.

• Learn how often you should have these tests and whether they will be scheduled and performed in the physician’s office.

• Ask how to prepare for any tests you may need.

• Take note of when and how you will receive the test results. All of your results are generally posted to your portal as soon as they are received. If a follow-up visit is needed, ask when it should be scheduled.

Medication Refill Policy – PLEASE READ CAREFULLY

Chronic use of habit-forming drugs is seldom in the best interest of patients or physicians. For this reason, our clinicians will NOT be responsible for prescribing chronic narcotics with very few exceptions. A prescribing agreement with strict parameters will be signed in the rare event that long-term use of these medications is required.

Innovative Urgent Care and Family Health Clinics participate with electronic prescribing directly to your mail order and local pharmacies. Our goal is to assist our patients with prescription requests in an efficient and timely manner. Due to the volume of prescription requests, we have created the following guidelines to help meet these goals.

• It is the patient’s responsibility to notify the office promptly when refills are necessary. Approval of your refill may take up to three (3) business days, so do not wait until you have depleted your current prescription. If you use a mail-order pharmacy, please contact us fourteen (14) days before your medication is due to run out. Appointments can be made on the same portal your refill requests are being sent through. Please use the portal for the fastest appointment requests.

• Medication refills will only be addressed during regular office hours Monday – Friday 8:00 am – 5:00 pm. No prescriptions will be processed after our regular business hours, on Saturdays, Sundays, or Holidays. Appointments can be made on the same portal your requests are being sent through. Please use the portal for the fastest appointment requests.

• Prescription refills require close monitoring by your provider to ensure its safety and effectiveness. Your provider will prescribe the appropriate number of prescription refills to last until your next scheduled appointment. Generally, when you are down to zero refills, it is time to schedule a follow-up appointment. We prefer you request any refills of your medications at the beginning of your office visit. Appointments can be made on the same portal your messages are being sent through. Please use the portal for the fastest appointment requests.

• Patients requesting new prescriptions, antibiotics, titrated weight loss medication refills, or ANY controlled substances (testosterone, phentermine, sleep/anxiety aids) MUST be seen for an appointment. NO EXCEPTIONS to this policy. They are not prescribed over the phone because they require an office or telemedicine visit. Please plan accordingly. Appointments can be made on the same portal your messages are being sent through. Please use the portal for the fastest appointment requests.

• Refills can only be authorized on medication prescribed by providers from our office. We will not refill medications prescribed by other providers or specialists. Appointments can be made on the same portal your requests are being sent through. Please use the portal for the fastest appointment requests.

• All prescriptions for controlled substances require a face-to-face encounter in the office with only your treating doctor. It is our strict policy that there will be no refills of controlled substances called in over the phone or by an after-hours clinician when the office is closed.

• Due to new insurance and state regulations, controlled pain medications are to be prescribed for a maximum of 7 days. Including prescriptions that are not new or for chronic pain, your insurance may limit you to a 7-day quantity. Quantities over a 7-day supply will require prior authorization. Patients must be re-evaluated in the office for controlled pain medication beyond 30 days. NO EXCEPTIONS.

• Patients are responsible for their controlled substance medication. You will need to be seen in our office every month for controlled medications, as we do not handle long-term pain management.

• We will not refill controlled substance medication prescriptions. If you require a refill of a controlled substance, and you are an established patient (for at least one month), you will be referred to a pain management specialist or other specialist related to your condition.

• Controlled substances/narcotic prescriptions require a follow-up appointment every 30-90 days.

• You will be asked to submit to a urine test to ensure compliance and safety of your controlled substance.

• It is important to keep your scheduled appointment to ensure that you receive timely refills. Repeated no-shows or cancellations will result in a denial of refills and possible discharge from the practice. Our EHR sends out multiple reminders of your upcoming appointments. It is each patient’s responsibility to notify us of needed cancellations. There are many others needing appointments and no-shows limit their ability to access care. A $25 no-show fee is currently in place. No-show fees must be settled before any future visits will take place. Our no-show fee increased to $50 in 2023. Appointment cancellations can be made on the same portal your requests are being sent through. Please use the portal for the fastest appointment requests.

• If you have any questions regarding medications, please discuss these during your appointment. If for any reason you feel your medication needs to be adjusted or changed, please contact us immediately. Appointments can be made on the same portal your messages are being sent through. Please use the portal for the fastest appointment requests.

• We reserve the right to charge an administrative fee if there are multiple requests for prescriptions requested outside of a visit.

• When it is medically necessary for our doctors to treat you with a controlled substance, we abide by all local, state, and federal regulations.

• If you are seeking a concierge weight loss management and hormone replacement service, we encourage you to visit www.sanavidawellness.com. That program offers direct and immediate access to Dr. Schanen, APRN using a HIPAA-compliant app for immediate response times for things related to refills and other inquiries. There is a full-time RN on staff who typically responds within 5-10 minutes during business hours. It’s a membership-based service for wellness care needs. No sick care is offered under that program. No insurance is accepted for wellness care but may be used for labs and medications.

You can schedule a visit for medication refills by using your patient portal.

Our providers participate in the Texas Prescription Monitoring Program (PMP). The Texas Prescription Monitoring Program collects and monitors prescription data for all Schedule II, III, IV, and V Controlled Substances (CS) dispensed by a pharmacy in Texas or to a Texas resident from a pharmacy located in another state. The PMP also provides a database for monitoring patient prescription history for practitioners and the ordering of Texas Schedule II Official Prescription Forms.

Pharmacists and prescribers, other than a veterinarian, will be required to check the patient’s PMP history before dispensing or prescribing opioids, benzodiazepines, barbiturates, or carisoprodol.

Pharmacists and prescribers are encouraged to check the PMP to help eliminate duplicate and overprescribing of controlled substances, as well as to obtain critical controlled substance history information.

Thank you,

The Team at Innovative Urgent Care

Treatment and maximum periods will vary by clinician, your length as a primary care patient, and your insurance carrier. All treatment plans vary by patient, compliance, and clinical judgment. (All periods
are subject to change without
notice.)

Blood Pressure and Cholesterol - 6 months (with labs)

Diabetes – controlled - 6 months

Diabetes – uncontrolled - 3 months (with labs)

Depression and anxiety – controlled - 6 months (with labs)

Depression and anxiety – uncontrolled - 3 months

New medications - 1 month

Allergy - 12 months

Birth control - 12 months (PAP & labs)

Female HRT - 3 months mammogram within last year is required.

Thyroid – controlled - without symptoms or weight changes - 6 months

Male testosterone - 1-3 months (with labs)

Controlled substances - 1-3 months

Anxiety medication - 1-3 months

Pain medication Non narcotic - 3 months

Sleeping pills - 1 month

ADHD - non-stimulant - 3 months

Weight loss and diet pills* - 1 month

* Diet pills require monthly follow-up to monitor weight and blood pressure.

(Please read this very carefully)

Innovative Urgent Care and Family Health Clinics is committed to reducing waste and inefficiency and making our billing process as simple and easy as possible. Starting January 1, 2023, we now are requiring that you provide a credit card on file (CCOF) with our office. We run our payments through our HIPAA-compliant, secure practice management software Athena. When you come in, we will scan your card with a card reader. Your payment information is stored on Athena’s secure servers for future transactions. Office personnel will not have access to your card. For your protection, only the last 4 digits of your card will show in our system.

Credit Card on File will be used to pay account balances after insurance adjudication. Co-pays will still be collected at each visit (if applicable). We will submit all patient claims to insurance as usual. Once your insurance has processed your claims, they will send an Explanation of Benefits (EOB) to both you and our office showing what your total patient responsibility is. You typically receive the EOB before we do, so if you disagree with the patient responsibility amount owed, it is your responsibility to contact your insurance carrier immediately.

Notes:

During the time you leave a credit card on file, if it expires or otherwise becomes uncollectable, we will expect you to promptly provide a new means of payment.

Credits on your account after your insurance claim has been adjusted will be returned to the credit card on file. Ultimately, you are responsible for knowing what services are covered, how often, and how much of the cost is your responsibility. You will be responsible for any portion of services that your insurance does not cover.

To avoid any issues of discrimination or favoritism; all patients will be required to have a credit card on file regardless of insurance or visit type.

FAQs:

When I booked my appointment, the receptionist told me I had to keep a credit card on file with the office. I’ve never heard of that before.

This is not surprising that this is new to you, as it is not yet the norm in this area. Credit Card On File (CCOF) is the new standard in the healthcare industry nationwide, and soon all of the high-quality medical practices will adopt it. We are not the first to do this. Insurance reimbursements are declining and the expectation is that health care providers find ways to become more efficient. With the Affordable Care Act and the Health Exchanges, we are seeing a massive increase in patient deductibles. These factors are driving many medical offices and clinics to either squeeze more patients into shorter periods or stop accepting insurance. We have decided to focus on becoming more efficient instead.

How does CCOF work? I’m nervous about giving up my sensitive financial information.

Your card information is securely protected by the credit card processing component of our HIPAA-compliant practice management system. This system stores the card information for future transactions using the same sort of technology that credit card companies use. We cannot access the entire card number – we only can see the last 4 digits. There is no way to export the card information out of our system. We can only use it to process a payment in our practice management system, which creates an indelible record (one that cannot be deleted).

How does the credit card on file system work to drive down administrative costs?

Our staff will now spend less time entering credit card information for each transaction. We also don’t have to send out as many statements, which saves trees, money, and time. Once your CCOF is in our system, check-in and check-out time is much shorter for you as well.

I always pay my bills on time. Why do I have to do this?

The entire billing process is wasteful but the few patients that we have to bill multiple times or even send to a collections agency do cost us a lot of time and expense. Reducing unnecessary costs is essential for us to continue to accept insurance and Medicare. This new process dramatically cuts down on the administrative costs associated with billing. We have already dropped Medicaid due to the billing inefficiencies and administrative burdens.

Nothing is changing about how much you pay. When you come into our office and receive a service, you do so with the understanding that you are ultimately responsible for the cost of your care. We bill your insurance company for you, and we have contracts with most insurance companies that help to get you the best possible coverage for your care. CCOF will only cover your responsibility after your insurance pays its contracted share.

How the CCOF process benefits patients.

First and foremost, it is far more convenient for you – you don’t have to call the office, buy a stamp, or worry about getting around to paying the bill. It takes the hassle out of the process, especially for patients who have HSA cards to pay for their medical care. If you get your statement and want to use a different card, pay by check, or discuss a payment plan, you may still do so as long as you do so promptly.

What if there is a problem with my bill and I don’t notice it until after the payment process?

We hope that this doesn’t happen. Although we love technology in this office, we routinely review the accuracy of claims processed by insurance and will contact you if WE find a problem. But, if you find a problem, call us and we’ll investigate it. If we owe you money, we will refund it promptly to the same card, instantaneously.

The only patients not required to provide a “Card on File” are listed. All other patients must provide a “Card on File”.

Patients experiencing a medical emergency

Medicare or dual coverage patients

Self-pay-Fee For Service or DOT patients when the visit is paid in full at the time of service,

Occupational Medicine and Workers’ Compensation patients

Direct Primary Care (DPC) members of our sister company Sana Vida Wellness Center.

What happens if I do not have a credit card?

We also accept:

HSA

HRA

FSA

Debit Card

CareCredit

What is a deductible and how does it affect me?

An annual deductible is the dollar amount you must pay out of pocket during the year for medical expenses before your insurance coverage begins. For example, if your policy has a $500 deductible, you must pay the first $500 of medical expenses before your insurance company begins to pay for any services.

How will I know if my deductible has been met?

You may find out when your deductible is met by calling your insurance company at any time. Some insurance companies also have this information available online.

For those who refuse to follow our new policy, we will offer them a cash office visit fee to be paid before seeing their clinician each time. Today’s cash price for care is $159 but is subject to change with advanced notice. We are a transparent company. A complete list of in-network carriers, a comprehensive list of our cash fees, and a copy of our CCOF policy can be found on our website at https://innovativeuc.com/insurance.

Thank you,

Dr. P. John Schanen, APRN, FNP-C, ENP-C

President and CEO

We understand that situations arise in which you must cancel your appointment. It is therefore requested that if you must cancel your appointment you provide more than 24 hours notice. This will enable another person who is waiting for an appointment to be scheduled in that appointment slot. With cancellations made less than 24 hours notice, we are unable to offer that slot to other people needing care.

As a courtesy, and to help patients remember their scheduled appointments, Innovative Urgent Care & Family Practice Clinics sends text message and email reminders 9 days, 7 days, 4 days, and 24 hours in advance of the appointment time.

Office appointments which are cancelled with less than 24 hours notification may be subject to a $75.00 cancellation fee.

Patients who do not show up for their appointment without a call to cancel an office appointment are considered a NO SHOW. Patients who No-Call, No-Show three (3) or more times in a 12 month period, may be dismissed from the practice, thus they will be denied any future appointments.

The Cancellation, No-Call, No-Show fees are the sole responsibility of the patient and must be paid in full before the patient’s next appointment.

We understand that special, unavoidable circumstances may cause you to cancel within 24 hours. Fees in this instance may be waived but only with management approval.

Innovative Urgent Care & Family Health Clinics believes that a good clinician/patient relationship is based upon understanding and good communication. Questions about cancellation, no call, no show fees should be directed to the clinic manager at (210) 455-6253.

If you require lab work prior to getting your prescription refill, then you must make a future office appointment at the same that the lab order is written. This is to ensure that the lab results are available for your clinician to review with you when the refill prescription is written.

In order to ensure the confidentiality of your protected health information and to give you the time and attention you need from your healthcare provider, you will be asked to schedule a follow-up appointment to discuss your test results (including lab work). If your test results need to be discussed before your scheduled follow-up appointment, our office will contact you immediately.

Many medications require prior authorization. Depending on your insurance this process may involve several steps by both your pharmacy and your provider. Once the prior authorization form is completed, both the pharmacy and our clinician’s office must wait for approval.

Neither the pharmacy nor the provider can guarantee that your insurance company will approve the medication. You may be required to make an office appointment to complete the process.

We accept most private insurance. Please be prepared to show your insurance card at every visit. Keeping your records up to date helps us expedite referrals and authorizations necessary for your care and ensures we have the information needed to bill your insurance company accurately and timely.

Payment is due at the time services are rendered. Your payment may consist of an insurance deductible, a co-payment, co-insurance, or full payment for uninsured patients or those services not covered by an insurance plan.

As a courtesy, we will bill your insurance company for you. If there is a difference between what they pay and the actual bill, you will be expected to pay the balance to our office.

Medicare

Medical care must be deemed medically necessary to be covered by Medicare.

You need to understand that Medicare does not cover everything and it does not pay the total cost for most services or supplies that are covered. You should talk to your doctor to be sure you are getting the services and supplies that best meet your healthcare needs.

The amount of your coverage is also dependent on whether you have coverage under Medicare Part A, Medicare Part B, or both.

Medicare Part A helps cover your inpatient care in hospitals, including critical access hospitals and skilled nursing facilities (not unskilled or long-term care). It also covers hospice care and some home health care. You must meet certain conditions to get these benefits.

Medicare Part B helps cover physician services, outpatient hospital care, and some other medical services that Medicare Part A doesn’t cover, such as some of the services of physical and occupational therapists and some home health care. Medicare Part B helps pay for these covered services and supplies when they are medically necessary. It also covers your annual preventive services.

If you belong to a Medicare+Choice plan, it must cover at least the same benefits covered under Medicare Part A and Part B. However, your costs may be different and you may have extra benefits, such as coverage for prescription drugs or extra days in the hospital. You should contact your Medicare+Choice plan administrator for specific coverage information for the plan in which you are enrolled.

Medicaid

At this time, we do not accept Medicaid for primary care services.