LOWCOUNTRY ORTHOPAEDICS & SPORTS MEDICINE POLICIES

Completion of ANY Forms Turned In To Lowcountry Orthopaedics

There is a $15 completion fee for any type of form submitted to this office.  This fee must be paid by cash or credit card at the time the form is submitted.  No forms will be faxed to employers, disability companies, etc.  Because of the volume of forms received by Lowcountry Orthopaedics, it may take up to 15 business days to process your form.

Prescription Refill Policy

Please call our office between 8:30-5:00 for new prescription or refill requests.  Please make note that prescription requests REQUIRE 24 BUSINESS HOURS TO PROCESS.  With this in mind, please do not wait until your medication is completely out before calling. The on-call physician on Saturdays, Sundays, or holidays will NOT authorize any medication requests.  Please call your pharmacy to verify that your prescription has been called in.  Please do not call our office after your initial request for medication.  If there are any issues with your request, you will be notified by the medical assistant.

Medical/Financial Policy

I, the undersigned patient or guarantor, hereby authorize my physician and whomever he/she may designate as his/her assistant to render medical treatment to me.  I further hereby authorize my physician and whomever he/she may designate as his/her assistant to release any medical information accumulated in the course of my examination and treatment to any other doctor, hospital, or other party assisting my medical care.  I further hereby request payment of benefits to this physician's practice when this practice accepts assignment.  I authorize use of Photostat copies of this assignment in lieu of the original when necessary.  I understand that I am responsible for any amount not covered by insurance/deductible/co-payment, Including but not limited to DME, Medicare, Medicaid and Select Health patients, including but not limited to codes; L3250, L3260, L3265, A4466. Lowcountry Orthopaedics will not take secondary payer adjustments.  Regardless of work comp or insurance coverage, insurance claims which are not paid in full within thirty (30) days will be my personal obligation.  Any and all collection fees, processing fees, and court fees are my responsibility and will be added to my account balance.

Medical Records Requests

If you would like a copy of your medical records, there is a $15 upfront processing fee plus $0.65 per page after 25 pages and actual postage.  Medical records will be reproduced in accordance with the South Carolina Code of Laws, Section 44-115-80.  Medical records will be forwarded to another physician for transfer of care at no charge.

X-ray/MRI Requests

If you would like a copy of your x-rays and/or MRI images, you'll need to sign a release and you will be charged $15 per CD (MRI) or $15 per x-ray sheet.  We will be happy to sign out these images free of charge if they are going to another physician/medical care facility.  Otherwise, it will take 48 hours to process your request.  The processing fee must be pre-paid by cash or credit card only.

Co-Pays and Past Balances

Co-pays are DUE AND PAYABLE at the TIME OF SERVICE. Please do not ask to be billed. All copays/coinsurances not paid the day of service may have a $10 processing fee added to your account. If you don't have your co-pay with you at the time of your appointment, you may be rescheduled to another date when you are able to provide payment.  All patients are required by their insurance carrier to have their co-pay and/or co-insurance at the time of service.  Lowcountry Orthopedics will be in violation of our contract with your carrier if we do not collect your co-pay and/or co-insurance at the time of service. We will make every effort to work with you regarding any past due balance issues.

Insurance Policies/Referrals

We participate with most insurance plans; however, it is your responsibility to call your insurance carrier to determine whether or not we participate with your particular plan.  Lowcountry Orthopaedics is considered a SPECIALTY practice.  Many insurances will not pay for specialty practice charges unless a referral is given from the primary care physician. If your plan requires a referral from your Primary Care Physician for Specialist office visits, you are responsible for obtaining this referral so that our doctors can see you.  Managed care requirements make it necessary for patients who do not have their referral at the time of appointment to either reschedule their appointment or make payment at the time of service.  Medicaid patients who are out of visits will be self-pay.

Worker's Compensation/Motor Vehicle Accidents/Liability Cases

Our office deals with these types of cases frequently and is knowledgeable in the proper care of those patients who are injured in liability situations. When making an appointment involving the situations mentioned above, verifiable contact information must be provided to our office. We will make every effort to assist you in obtaining the authorization for your office visits. However, if we are unable to obtain authorization, other payment options are available. You will need to contact your Third Party Liability\MVA insurance carrier and ask for Medical release form, sign this form and give it to LCO. We can then verify billing information and may be able to bill directly to the Third Party Liability\MVA. If you don't have Third Party Liability\MVA the claim may be billed to your personal PIP\MET pay part of your Auto Insurance coverage. We may also be able to file to your private health insurance but you will need to contact your Health Insurance carrier and ask for the subrogation department to report your accident. They will instruct you on how and where to fill out the paperwork. We will need a copy of this letter and/or information.

                                                                                                                   Rev 7/28/11