Health Maintenance Organization (HMO): Health Maintenance Organizations focus on prevention and wellness and tend to be the most structured managed care plan. Patients who have coverage through an HMO are required to select a primary care physician (PCP) affiliated with the plan. The PCP is responsible for coordinating care with specialty providers through the referral process. Physicians generally refer their patients to colleagues within the same provider system. Most services provided outside the primary care setting require a PCP referral. In addition to a referral, certain services such as outpatient surgery may require plan authorization from the health plan.

Preferred Provider Organization (PPO): Different from an HMO, patients do not have to select a primary care physician (PCP) to coordinate their care and are allowed to self refer (no referrals required) for specialty services. Also, unlike an HMO, patients may see a provider within the PPO network or obtain services outside the provider network. No referrals are required for specialty care, however certain services such as outpatient surgery may still require a plan authorization from the health plan. These requirements vary significantly with PPO type products.

Point of Service (POS): A health plan that offers the patient several options for receiving health care services. The benefit and copays costs will vary depending on the physician and hospitals the patient chooses. Patients with a POS product can choose to either coordinate care through their PCP or self-refer (no referrals required) for specialty care. The least expensive option is using your POS like an HMO, which means that you coordinate your care with your PCP and get a referral prior to seeing a specialist. You may also choose to self-refer for specialty care. This means you do not have to see your PCP before seeing a specialist. These options allow you more choices but can result in higher out-of-pocket costs such as higher copays, deductibles, and/or coinsurance. With either option, certain services such as outpatient surgery may still require a plan authorization from the health plan.

To reduce any misunderstanding or confusion our practice has adopted the following financial policy. If there are any questions regarding our policy, please discuss your concerns with our staff. We are dedicated to providing the best possible care and service to our patients and regard their understanding of financial responsibility as an essential element of quality care and treatment.

Please be aware that there may be up to four fees billed when a endoscopy or colonoscopy procedure is performed. A bill for the doctor’s services (professional fee), a bill for the use of the surgery suite (facility fee), a bill for anesthesia sedation, and a bill for pathology if biopsies are taken.

Insurance is considered a method of reimbursing the patient for fees paid to the doctor/ambulatory surgery center and is not a substitute for payment. Some companies pay fixed allowances for certain procedures, and others pay a percentage of the charge. It is your responsibility to pay any deductible amounts, co-pays, co-insurance, or any other balance not paid for you by your insurance.

Unless other arrangements have been made in advance, either by the patient or their health insurance carrier, we will expect payment at time of service. For patient's convenience, we accept VISA, and MasterCard as well as cash and personal checks.

We have a contractual relationship with many insurance companies to accept assignment of benefits. We will bill those plans for which we have such a relationship and will only require our patients to pay the authorized co-payments, deductibles, or coinsurance at the time of service. It is our office policy to collect all co-payments at the time of service.

If the patient has insurance coverage with a plan with which we do not have a contractual relationship, we will prepare and send a claim form on an unassigned basis. The insurance company will directly pay the patient who is responsible for remitting payment to GI Specialists of Clarksville, PC and to Anil Patel, MD, PC. All charges will be the responsibility of the patient and payment in full is due at the time of service.

In the event that the patient's health plan considers service to be a "non-covered" service, the patient will be responsible for the entire charge. Payment in full will be due at the time of service.

We will bill the patient's health plan for physician services in the hospital. The same financial responsibilities apply.

Please determine prior to your visit if your insurance company requires pre-certification for your visit, hospital admission or procedure. Your insurance company may not pay for your bill if the service is not pre-certified. We do not guarantee your insurance benefits. Routine or preventative services may be non-covered services. You are responsible for the bill once service is rendered. Communicate with us to ensure payment by your insurance company.

We have relationships with the following insurance carriers. Many plans may not be listed due to their size, location, or affiliation with other plans. We highly encourage all patients to contact their employer benefits department or the member services department of their insurance carrier for the most accurate participating information. Please note that this is not an all-inclusive list of insurance plans accepted by GI Specialists of Clarksville, PC. If you do not see your insurance above, please call us. A referral from your primary care doctor is necessary if you have a POS or HMO insurance policy.

*Note: this list is subject to change at any time.

• Aetna
• Amerigroup
• Americhoice
• Anthem
• Blue Cross Blue Shield
• Blue Choice Health Plan
• Blue Cross/Blue Shield (PPC/PPO/POS/State Health Plan)
• Beech Street
• Beech Street/Capp Care
• Bluegrass Family Health
• Choice Care/Humana
• Cigna
• Community Health Partners
• Coventry Health
• First Health Network
• Great West Healthcare
• Health First
• Healthspring
• Humana

• Humana Gold
• Integrated Health Plan
• Kanawha
• Med Cost
• Medicare
• Medicare Managed Care Plans
• Multiplan
• Optimum Health Network
• Planned Administrators
• Premier
• Private Health Care Systems
• Signature Health Alliance
• St. Francis Health System Preferred Plan
• Sterling
• Tricare
• Unicare
• United Healthcare
• USA Network
• Windsor

Please bring a list of all medications you currently take, including over the counter and herbal supplements. Include the exact name of medication, dose of medication, and how often you take it. If it is more convenient, you may bring your medication in its original container.

If you have any pertinent lab or x-ray reports that will assist in your evaluation, please ask your primary care provider to send those to us prior to your appointment.

Bring your current insurance card. Co-payments and deductibles are due on same day that service is provided. In addition to your insurance, we accept cash, check, or credit card.

During your first visit, a detailed medical history will be obtained. You can greatly assist us by bringing a complete list of your current medications and the results of recent medical tests or studies. The doctor will ask you questions about any previous illnesses and medications. The answers you give may help to successfully treat your present medical condition. A physical examination, especially directed to the areas pertaining to the gastrointestinal tract, will be performed. The doctor will then discuss further diagnostic tests, such as laboratory studies, X-rays and endoscopic exams that may help diagnose your condition.

The biggest complaint that most people have is the never-ending wait in the waiting room. It is frustrating to say the least. We try to alleviate the wait time as much as possible because we truly understand the value of your time and appreciate you choosing GI Specialists of Clarksville, PC as your digestive disease specialists. However, urgent work-ins need to be seen, referring physicians call to speak to our doctor, morning procedures take longer than expected to complete and various other demands are made of our doctor throughout the day.

We make every effort to schedule non-emergency appointments within a reasonable amount of time. Patients who are sick or have a serious problem, will be seen on the same day. To allow us to meet the needs of every patient, especially in cases of emergency, we ask that patients call our office promptly, preferably one day in advance, if they need to cancel their appointment or have the need to reschedule. If you fail to notify our office and miss a total of three scheduled appointments, we have the right to terminate you from our office practice. If we exercise that right, you will receive a certified letter explanation and will be given names of alternative Gastroenterologists to follow up with.

As a courtesy to other patients, please do not bring children to the office on the day of your appointment.

We strive to offer the best services and care for each patient in a timely manner. The following “rules” are essential and necessary to efficiently manage a busy clinic. Thank you in advance for your cooperation and understanding.

• There is a $15.00 charge for phone-in prescription refill requests.
• No prescriptions will be refilled on Fridays, Saturdays, Sundays or Holidays.
• Require 6 days minimum to process prescription(s) renewal and/or pick-up requests.
• The patient is responsible for knowing when medication(s) will need to be refilled (no early refills).
• Prescription phone-in/pick-up: Monday-Thursday during business hours ONLY (9am-4: 30pm).
• Prescriptions will not be filled for unauthorized “walk-in” patients.
• Non-controlled/non-narcotic prescriptions require a follow up appointment every 3-6 months.
• Controlled-substances/narcotic prescriptions require a follow up appointment every 30-90 days.
• New symptoms and/or events require a clinic appointment. Provider unable to diagnose via phone.
• Signed “Controlled-Substance/Narcotic Policy” required if using narcotic/controlled medications.
• No early refills if medications are overused/abused/misused. Must follow prescription directions.
• No medication/prescription will be replaced if lost, stolen, misplaced, overused, etc (treat like money!!).
• Medications are for the prescribed individual’s use only. It is illegal to “share” your medicine.
• Patient must pick-up his/her prescription(s) in person, unless pre-authorized by staff.
• Failure to comply may subject immediate termination of prescriptive medications.

As one of our patients, you have certain rights:

• YOU have the right to be treated with dignity by a competent medical staff.
• YOU have the right to expect privacy and confidentiality concerning your medical care. Information can only be released with your consent except as provided by the law or third party contracts.
• YOU have the right to receive accurate information about your problem in lay terms that you understand.
• YOU have the right to participate in choosing the best form of treatment for your problem.
• YOU have the right to consent to, or refuse, any care or treatment.
• YOU have the right to know the names of all individuals who directly participate in your care, and you have the right to select and/or change your doctor at any time.
• YOU have the right to ask any question about or services or any related cost.
• YOU have the right not be treated with discrimination.  It is the policy of GI Specialists of Clarksville, PC to admit and treat all persons without regard to race, color, national origin, handicap, religious or fraternal organization or age.

As one of our patients, you also have certain responsibilities:

1. YOU have the responsibility to be courteous to our staff and other patients.
2. YOU have the responsibility to keep your appointments and be on time. If you cannot keep a scheduled visit, please call us at once and reschedule or cancel so another patient can use that time.
3. YOU have the responsibility to provide your doctor and nurse with accurate and truthful information about your medical history so that an accurate diagnosis can be made.
4. YOU have the responsibility to follow the mutually agreed upon prescribed course of care, and you have the right to select and/or change your doctor at any time.
5. YOU have the responsibility to pay your bills promptly, to provide the necessary insurance information for processing them, and to ask any questions you have about them as soon as possible.