Important information about scheduling appointments, your privacy rights, fees, and payment for services

We realize that you have a choice about who you select as your healthcare provider, and we are grateful you have chosen us. We appreciate having you as our patient. Our providers and staff strive to offer the best medical treatment possible on your behalf.  We provide you with this brochure to explain how you can help us provide you with this high quality care.  Please remember that your comments or questions are always welcome.

Q: What if I’m late for an appointment?

A: If you are more than 10 minutes late for your appointment, we may have to ask you to reschedule out of consideration for patients who are on time for appointments that follow the time we had reserved for you.  We strive to keep wait times to a minimum because we understand that our patients’ time is valuable.  We expect you would not like to be kept waiting because a late arrival filled your appointment slot so we hope you will understand if we ask you to reschedule

Q: What happens if I miss an appointment?

A: Appointments are scheduled because you need medical attention.  Missed appointments delay our ability to provide that attention. We will gladly reschedule if you notify us at least 24 hours in advance.  Broken, or missed, appointments without 24-hour prior notice of cancellation are recorded in your record.  Additionally, a $25 “no-show” fee will be placed on your account.  If you “no show” for 3 appointments within a rolling calendar year, you may be dismissed from the practice, with notice.

Q: What should I bring when I come for my appointment?

A: We ask that you bring a photo ID and your current proof of insurance coverage to each visit in order to assist us in obtaining full insurance benefits on your behalf.  We may verify coverage prior to services being rendered.   If your insurance company does not show that you have an active policy, you will be required to make arrangements for payment in full prior to being seen by a medical provider.  If your insurance claims are denied by the insurance company, you will be billed.   Not all medical services are covered by health insurance, so we may ask you to accept financial responsibility for such services before they are provided.

Q: Must I pay at the time of service?

A: Yes.  You are responsible for any co-pay, deductible, or co-insurance.  This is part of the contract we (and you) have with your health insurance carrier.  For patients with high deductible health plans, a deposit of $50 will be collected at the time your visit.  If you do not have health insurance, a minimum deposit of $125 will be collected at the time of your visit.  Deposits collected will be applied to medical services received during your appointment.  You will then be asked to make arrangements for payment in full on any outstanding balance(s) prior to your departure.  If you are not prepared to prepay for co-pays, deductibles, co-insurance, etc., we may ask you to reschedule your appointment.

Q: What forms of payment do you accept?

A: We accept cash, personal checks (see below), and most credit and debit cards (including those drawing on funds in any HSA or HRA account that may be associated with a high deductible health plan). If any monies prepaid result in a credit on your account, you will receive a refund in a timely manner.

Q: What happens if my check bounces?

A: We will add a $25.00 fee to your account for any check returned to our office for insufficient funds or a closed account.  We will expect payment of the fee, plus the amount of the check, by cash, debit, or credit card upon receipt of notification by our financial institution before additional medical services will be provided.  PENTA will no longer accept payment in the form of a check in either of these situations.

Q: Can you help me complete medical forms?

A: Yes.  Due to the high volume of requests for completion of medical forms, we do charge a form completion fee of $10 to $15, depending on the level of detail, complexity and time required to complete the form.

Q: Can I get copies of my medical record?

A: Yes.  Upon receipt of written authorization, requests for copies of medical records will be accomplished within 1-2 weeks of receipt of your request.  Our fee for records duplication follows North Carolina statute.  The minimum charge is $10.

Q: What about my privacy rights?

A: Patient privacy rights are addressed by the Health Insurance Portability and Accountability Act (HIPAA).  We are HIPAA-compliant and encourage you to become familiar with our Notice of Privacy Practices.  This notice can be found in our waiting areas, and if you desire, you will receive a free copy.  You can also view it on our website.

Q: What other services do you offer?

A: Allergy diagnosis and treatment, cosmetic injectables and facial plastic surgery, aesthetic products and procedures, hearing aid sales and service,  onsite CT imaging , and clinical research.