Operating Policies & Procedures

OFFICE HOURS

Monday 8:00 am – 4:30 pm, Tuesday-Friday 8:00 am – 3:30 pm.
We are closed for lunch between 12:00 pm – 1:00 pm on Mon/Wed/Fri,
and from 12:00 pm – 12:30 pm on Tue/Thurs.

EMERGENCY/AFTER HOURS

: You must dial 911 to seek immediate medical attention

APPOINTMENTS SCHEDULING

We seek to accommodate the needs of our patients and will schedule your appointment at the most convenient time possible,. However, we will need all records from previous doctors who treated you for the same condition including Primary Care Physicians. These records usually must be reviewed by our doctor prior to schedule your appointment.

APPOINTMENT REMINDER CALLS

Central Florida Pain & Rehab Clinic will attempt a courtesy reminder text to patients prior to their scheduled appointment. This is not an obligation and the patient will be responsible for keeping the appointment time. In case of a patient phone number change or disconnection, the patient is responsible to communicate with us to confirm the appointment. If patient does not confirm an appointment, Central Florida Pain & Rehab Clinic reserves the right to cancel the appointment and charge the no-show fee

APPOINTMENT ARRIVAL TIME

Patients must arrive on time to the scheduled appointment. Our office reserves the right to not see a patient past their appointment time.

NO-SHOW/LATE CANCELLATION POLICY

Failure to keep a scheduled appointment has, in effect, prevented another patient from receiving medical care during the allotted time slot. Cancellations or reschedules must be received 24 hours in advance for follow up appointments, and 48 hours in advance for procedures, so that we may accommodate patients who need to be seen. If a patient fails to no show or late cancel for an appointment and does not provide the proper notice, a no-show or late cancellation fee will be charged. No Show/Late Cancelation fees are as follow: Follow Up Visits $ 25.00, Procedures $ 75.00, EMG/NCS $ 100.00. These charges will not be billed to an insurance provider. Your appointment time is allotted to you so we will charge you for failure to call.

INSURANCE AND DEMOGRAPHIC INFORMATION

We must verify your insurance and demographic information at each visit. This ensures that we process accurate billing for you and your insurance company. You must notify the office of any changes regarding your demographic or insurance information. Changes of insurance must be verified prior to your visit, otherwise your appointment might be rescheduled. If you do not have your insurance card or insurance information available at the time of your initial visit, you will be considered self-pay and payment will be expected at the time of service.

PAYMENTS AND COLLECTION FEES

Your co-pay, co-insurance amount and/or deductibles are due at the time of service. We are unable to discount, waive or bill these fees at a later time due to our contracts with the insurance companies. All outstanding balances are also due at the time of your visit. If, for an unforeseeable reason, you do not have the co-insurance amount and/or deductible with you at the time of service, please be aware that Central Florida Pain & Rehab Clinic may charge you an administrative surcharge of $15.00 for processing these payments after your visit. You may be asked to reschedule your appointment if you are unable to make payment. We accept Cash, Visa and MasterCard.

If any pending balance it is not paid within 30 days, a 1.5% finance charge per month will be added. Accounts past due after 90 days, are
turned to a collections agency. An additional 40% fee is added to account balances once they are turned to collections.

INSURANCE BILLING

As a courtesy, our office will file your insurance if you provide us with the proper information. You are expected to pay your deductible and any out-of-pocket portions at the time services are rendered. In the event your insurance overpay, we will refund you promptly. Since your insurance coverage is a contract between you and your carrier, if payment is not received from them within 60 days, you are immediately responsible for the remaining balance.

COMPANION POLICY

Central Florida Pain & Rehab Clinic requests scheduled patients bring only one companion to an appointment. In the event that more than one person accompanies a patient, only one will be permitted in the clinical area. All other members must remain in the waiting room. If you must bring your child/children, for their own safety they have to remain in the waiting area during all your appointment time. If your child/children are under the age of 8, and adult must accompany them during your visit.
Central Florida Pain & Rehab Clinic will not be responsible for unattended child/children.

COMPLETION OF FORMS

Employer, FMLA, insurance forms, Disability or any other paperwork that requires your provider's input, can be very time consuming for both you and your provider. Please be sure to complete all required information with your provider to review the requested information. There is a required prepayment of $10.00 per page. Processing time takes up to 10 business days after payment is received.

PRESCRIPTION REFILLS

Please do not wait until you are out of your medication. Allow at least two working days for the provider to approve refills or for an available appointment. Medico-legal reasons require the doctor to examine the patient in the office before giving a diagnosis or offering treatment. Therefore, a patient must be seen in a monthly basis to get any controlled medication. We will not accept refill requests on Fridays after 2pm. Controlled substance prescription refills will not be made after office hours or on weekends. Due to the nature of our practice all patients taking controlled substances are subject to random urine drug screening test and pill counting. In case of a patient refusing the test or an abnormal screening result, prescriptions may be denied and the patient might be discharge from the practice.

TEST RESULTS

Good medical care cannot always be accomplished over the phone, so we may advise you to schedule an office visit to discuss your concerns, problems, or test results. Test results may take up to a week and it is recommended that the patient schedule an appointment around that time to review the results with the physician. If you have any questions about bills received for lab services or diagnostic tests, we ask that you contact the service provider directly. Central Florida Pain & Rehab Clinic has no knowledge or jurisdiction on any other service provider.

REFERRALS & AUTHORIZATION

A referral from your Primary Physician may be needed to receive any treatment or to be seen at our office. We will request the referral or authorization from your primary doctor as a courtesy to you, however it is the patient’s responsibility to make sure that the proper authorizations are given before the scheduled appointment. You may contact your primary doctor directly to request the referral or the authorization needed. If your insurance does not require a referral from your primary care, you may contact our office directly to schedule an appointment. If you are scheduling your initial appointment all previous medical records related to the condition for which you are requesting the appointment will be requested and must be received and may be reviewed by our physician prior to your appointment been scheduled. A release of medical records enables us to obtain your medical records from your previous physicians. If at all possible, you can download this document from our web page www.cfprc.com and fax it to us prior to your visit or come by our office to sign this form.

REQUESTS FOR MEDICAL RECORDS

We will release copies of a patient's medical record with written, signed patient authorization. Standard legal fees for copies apply if records are requested by the patient or if they required to be printed and mailed. You will not be charged a fee for records requested by a physician to whom we have referred you or any physician’s office that will accepts records via facsimile.

TERMINATION FROM OUR PRACTICE

Our office values its patient relationships and wants to protect patients' rights. We will only terminate patient relationships with cause and after careful consideration. Reasons for termination include: repeated no-showing for scheduled appointments; not complying with recommended medical care; being hostile or abusive to staff; not compliance with the Narcotic Agreement, refusing the drug screening tests or not paying bills in a timely manner.

HEALTH INSURANCE PORTABILITY & ACCOUNTABILITY ACT (HIPAA)

The federal government requires us to share our Privacy Notice, you can request a copy at the front desk, or download it from our website www.cfprc.com.

PLEASE REMEMBER: Please be advised, that we do not accept walk-ins, you must call to schedule an appointment with us. Cell Phones are not allowed in the clinical area. No food and drinks are allowed in the office. Due to limited space no strollers are allowed in the clinical area.

Thank you for choosing Central Florida Pain & Rehab Clinic for your health care needs and for helping us provide the best care possible to you!

By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.

Spanish Version: Por motivos legales el consentimiento del paciente debe estar consignado en este documento en inglés, pero si usted no tiene claridad con respecto a algo aquí relacionado, favor solicite la versión en español del mismo a nuestro personal.