Office Policies

In order to reduce confusion and misunderstanding between our patients and the practice. We have adopted the following financial policy. If you have any questions about the policy, please discuss them with our office manager. We are dedicated to providing the best possible care and service to you and regard your complete understanding of your financial responsibilities as an essential element of your care and treatment.

1. As a courtesy, we fill file your insurance claim for you if you assign the benefits to the doctor. In other words, you agree to have your insurance pay the doctor directly. If your insurance company does not pay the practice within a reasonable length of time, (within 45 days) you may be responsible.
2. Your insurance policy is a contract between you and your insurance company, the doctor is not involved.
3. We have made prior arrangements with many insurers and other health plans to accept an assignment of benefits. We will bill those plans for which we have an agreement and will only require you to pay the authorized co-payment at the time of service. We will collect the co-payment at the time of the service.
4. If you fail to notify us of an insurance change, you are fully responsible for any amount not paid by your insurance company.
5. Unless either you or your health coverage carrier have made other arrangements in advance, full payment is due at the time of service. For your convenience, we will accept VISA and MasterCard.
6. All health plans are not the same and do not cover the same services. In the event your health plan determines a service to be “not covered”, you will be responsible or the complete charge.
7. For all services provided by our physician(s), in the hospital, we will bill your health plan. Any balance due is your responsibility.
8. For all services rendered to minor patients, we will hold the parent or guardian accompanying the minor responsible for expenses incurred.
9. In order to provide the best possible service and availability to all our patients, please call us as early as possible if you know you need to reschedule your appointment. There is a late cancellation fee if you do not cancel or reschedule your appointment within 24 hours.

We understand that there are times when you must miss an appointment due to an emergency or family/work obligation. However, when you do not call to cancel the appointment, you may be preventing another patient from getting much-needed treatment.

If an appointment is not cancelled at least 24 hours in advance, you be charged a $50 fee. This fee is not covered by insurance companies.

Nuclear Stress Testing

Requires us to purchase pharmaceutical supplies specifically for your test. These supplies cannot be returned as it is a nuclear portion of the test.

Failure to show or cancel your appointment within 48 hours will result in a charge of $160.

TLC Medical Group s contracted with many insurance companies. It is the responsibility of the patient to make sure we are contracted with your insurance company. If unsure, you may simply call the number listed on your insurance card to verify.

Participating Insurance Providers Include:

• Medicare

• Railroad Medicare

• Blue Cross Blue Shield Florida - All Product Lines

• Freedom Health

• Careplus

• Humana

• Wellcare

• Tricare

• Aetna-PPO

• Multiplan Network

• Some United Healthcare (check with your plan to verify)

Not covered by any of these plans? Contact us and we will find the best solution to suit you, including helping you use out-of-network benefits.

HIPAA NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

When this Notice of Privacy Practices refers to “we” or “us”. It is referring to TLC Medical Group and all of the employees of our company. We are required by law to maintain the privacy of your protected health information (Phi), follow the terms of the Notice currently in effect, to give you this Notice setting forth our legal duties and privacy practices concerning your PHI and to notify affected in individuals following a breach of unsecure PHI. This Notice describes how we may use and disclose your PHI. Additionally, this Notice explains the rights you have with respect to your PHI, and certain obligations we must abide by in accordance with the law. We reserve the right to amend this Notice. If we make any material revisions to this Notice, we will post a copy of the revised Notice in lobby on our patient communication board.

1. USE AND DISCLOSURE OF YOUR PHI – We will use and disclose your PHI for treatment, payment and health care operations. We may also use your PHI for other purposes that are permitted and/or required by law and pursuant to your written authorization. The following lists examples of how we may use and/or disclose your PHI. Any other uses not described in this Notice will only be made with your explicit authorization, which you may revoke at any time by providing us written notice of your revocation.

A. Treatment - We may use and disclose your PHI in order to provide medical care services. We may disclose your PHI to your other treating physicians at either their or your request (with written authorization)

B. Payment - We will use and disclose your PHI in order to obtain payment for the health care services we provide to you. We may also need to disclose your PHI to receive prior approval from your health plan for your care and treatment

C. Family Members, Relatives or Close Friends - Unless you object to such disclosure, we may disclose your PHI to your family members, relatives or close personal friends, or any other persons you identified by you as being involved in the treatment or payment for your medical care. If you are not present to agree or object to our disclosure of your PHI to a family member, relative or friend, we may exercise our professional judgement to determine whether the disclosure is in your best interest. If we decide to disclose your PHI, we will only disclose the PHI that is relevant to your treatment tor payment.

D. Other Permitted and Required Uses and Disclosures – We may use your PHI without obtaining your authorization and with offering you the opportunity to agree or object as follows:

• • As required by law, provided however, the use or disclosure will be made in compliance with applicable law;
  • To a public health authority that is authorized by law to collect or receive such information, or to a foreign government agency that is acting in collaboration with a public health authority and these health activities generally include preventing or controlling disease, reporting deaths, reporting adverse effects of medications, notification of communicable disease and reporting abuse r neglect under certain circumstances
  • To a health oversight agency for oversight activities authorized by law, including audits and inspections, and civil, administrative or criminal investigations, proceedings or actions
  • For judicial or administrative proceedings purposes in response to a subpoena, court order, discovery requests, etc…but only if efforts have been made to inform you about the request or to obtain an order protecting the information request
  • To law enforcement to report certain injuries, comply with court orders or warrants or similar process, to identify a suspect, fugitive, issuing person or victim or to report a crime
  • To a coroner or medical examiner to perform duties authorized by law such as identification of a deceased person or determining the cause of death
  • To funeral directors consistent with applicable law, as necessary to carry out their duties
  • To organ procurement organizations or similar entities for the facilitating organ, eye or tissue donation and transplantation
  • For research purpose provided that certain approvals take place and assurances are given
  • To avert a serious threat to health or safety, so long as the disclosure is only to a person who is reasonably able to prevent or lessen such treat
  • For military and veterans activities (including foreign military personnel) to assure the proper execution of a military mission and to determine eligibility of benefits
  • For national security and intelligence activities for the purpose of conducting lawful intelligence, counter intelligence and other nation security activities
  • To a correctional institution or law enforcement custodian if you are an inmate or under custody and;
  • To the extent necessary to comply with laws relating to workers’ compensation and work-related injuries

2. YOUR RIGHTS AS OUR PATIENT - As our patient, you have of rights associated with your PHI. The following describes your rights:

A. You have the right to request restrictions or limitations on how we use and/or disclose your PHI, however, we do not have to agree to your request restriction or limitation (except for any transaction you paid for in full out of pocket). You written request must specify: 1. If you would like to restrict or limit our use and/or disclosure 2. What information you want restricted or limited and 3. To whom the restriction or limitation applies. If we agree to your request, it will not prevent us from disclosing your PHI as follows: 1. To you if you request access or an accounting of disclosure 2. For purposes required or permitted by law or 3. In case of an emergency

B. You have the right to receive confidential communications concerning your PHI by alternative means or via alternative locations. If you wish to receive confidential communications via alternative means or locations , please submit your request in writing to the Privacy Officer and set for the alternative means by which you wish to receive communication or the alternative location at which you wish to receive such communications. We will accommodate all reasonable requests.

C. You have the right to access, inspect and obtain a copy of your PHI, including any electronic PHI; provided, however, you are not entitled to access certain PHI exempted under HIPAA. To the extent we maintain electronic PHI, upon request, we will provide you with a copy of your PHI in the format requested. If we do not have your PHI in our possession, we will provide you with the appropriate contact information when your request is received. If you request a copy of your PHI, you will receive a response to your request in a timely fashion but may be charged a reasonable, cost based fee to cover copy costs and postage. In some limited circumstances, we may deny our request for access to PHI in which case you may request for the denial to be reviewed. If access is ultimately denied, you are entitled to a written explanation with the reason for the denial.

D. You have the right to receive an accounting of disclosure of your PHI made by us, including disclosures to or by our business associate(s) for a period of six years prior to the date on which you request an accounting of disclosures or such lesser period you indicate. You will receive a request annually, free of charge and, thereafter, we may charge you a reasonable cost based fee for each subsequent request for accounting of disclosures within the same twelve-month period. We will notify you of the cost for an accounting of disclosures and you may choose to withdraw or modify your request before we charge you.

E. You have the right at any time to obtain a paper copy of the Notice, even if you received this Notice electronically. Request for a paper copy of this notice in writing to the Privacy Officer at the address listed below

3. Additional Information

A. If you need any additional information about this Notice or which to exercise any of your rights set for this notice, please contact the Privacy Officer at the following address: TLC Medical Group, attention Nancy Witherow, 1391 NW St. Lucie West Blvd. #216, Pt. St. Lucie, FL 34986

If you believe your rights have been violated, you may file a complaint without retaliation to:

Secretary of the Department of Health and Human Services

200 Independence Avenue SW

Washington, DC 20201

Nuclear Stress Testing requires us to purchase pharmaceutical supplies specifically for your test. These supplies cannot be returned as it is a nuclear portion of the test.

Failure to show or cancel your appointment within 24 hours will result in a charge of $160.

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You can download the new patient form packet right from our website. You can also retrieve copies on the day of your appointment when you check in.

Download the new patient forms now.

Please remember to bring proper identification, insurance cards, preferred pharmacy information and payment method with you to your appointment.

TLC believes that students are our future! We are proud to display we are a teaching facility. Not only does hosting students help them, but it also helps our team keep up with their field changes, practices and latest technology - ultimately providing you the best experience possible.

What that means for our patients is an added layer of care!

All students are supervised by a physician or their related field managers. If at anytime you wish not to have a student assist, please inform one of our team members.

In the event that we are not contracted with your insurance, many companies offer out of network benefits. We will work with you to utilize the out of network benefits. Please ask to speak to our billing department for further details. You may reach them at 772-877-8578 Ext. 207.

American College of Cardiology – Practice guidelines, news and information about ongoing educational programs.

American Society of Echocardiography – The American Society of Echocardiography is an organization of professionals committed to excellence in cardiovascular ultrasound and its application to patient care through education, advocacy, research, innovation, and service to our members and the public.

American Heart Association – Information on heart disease and stroke.

Heart Rhythm Society – Group represents all specialties of cardiac pacing and electrophysiology. Find a newsletter, membership details, and conference detail.

Heart Failure Online – This bilingual web site is dedicated to patients with heart failure.

hfsa.org – Patient education and testimonials provided for you by the Heart Failure Society of America.

eatright.org – Your link to nutrition and health.

nutrition.gov – This site provides food facts, food safety and information of lifecycle issues for you overall well-being.

www.nhlbi.nih.gov – A comprehensive site from the National Institutes of Health for patients with heart disease. It covers all aspects of heart disease with special emphasis on high blood pressure, cholesterol and obesity.

www.unos.org – The site from United Network for Organ Sharing provides information for heart transplant patients and those on the transplant waiting list.