PHONE 831-288-3400     FAX 831-288-3405
243 GREEN VALLEY RD #A, FREEDOM, CA 95019
831FEET.COM

We realize there are many choices and are pleased you have chosen Pacific Point Podiatry for your foot and ankle care. Our staff strives to make your experience as pleasant as possible. To maintain a high level of care, the following policies are implemented:

Office Hours For appointments, prescription refills and test results, please calls our office during normal business hours. Prescription refills may take 1-2 days, so be sure to plan ahead. Antibiotics and narcotics may not be prescribed over the phone. We do not prescribe narcotics routinely, you may need to see a pain specialist instead.

Urgent Care We offer walk-ins on a first come first serve basis, schedule permitting. If we are unable to accommodate you, you should go to the nearest urgent care center or emergency room for true emergencies. Pain medication refills are not considered true emergencies so plan ahead and make arrangements with your primary care doctor or pain specialist who can better serve your needs.

Appointments Occasionally, we encounter office emergencies or patients requiring more time. We hope you understand and accommodate for these rare instances that may delay your appointment time. We encourage you to reschedule so that you can have the time and attention you deserve.

Telemedicine/Telehealth We offer appointments by phone and/or video conferencing at your convenience and will bill your health insurance accordingly. If this is not a covered benefit, you will be responsible for payment.

Other We give and expect a respectful and professional environment for all who come through. We reserve the right to refuse care in patients who are rude, threatening, or intimidating to any staff member of Pacific Point Podiatry.

Credit Card on File Policy 

Pacific Point Podiatry is committed to making our billing process as simple and easy as possible. We require that all patients provide a credit card on file with our office. We will scan your card with a card reader. It will store your card number in a secure, compliant location in your electronic medical record. For security reasons only the last four digits will be visible to our staff. Credit cards on file will be used to pay copays when you are seen in our office, including account balances, after your insurance processes your claim.

If we do not receive payment for the amount listed on your statement within 13 days, we will run the credit card on file for the full amount owed. If your payment is declined, we will call you.  If our reminder call is not returned within one week, a $35 declined payment fee will be applied and another statement will be mailed. Your account becomes delinquent if not paid within 30 days after the date of the original statement.  The unpaid balance will be subject to a finance charge of $35. Further delinquency will be subject to collections with additional finance fees.

By becoming a patient, I consent Pacific Point Podiatry permission to charge my credit card for any patient balance due, including deposits, on my account. If I have insurance coverage, my card will be charged AFTER my insurance has paid their portion. 

If You Do Not Have Health Insurance We warmly welcome self pay patients. Payment is due at the time of service.

• Our relationship is with you, the patient, and not the insurance company. You are responsible for understanding your coverage including co - payments, deductibles and non - covered services since your insurance policy is a contract between you and your insurance company.  Therefore, if you have questions about your policy, contact your insurance carrier.
• Cost/payment cannot be guaranteed since insurance policies are always changing.  As a courtesy, w e will bill your insurance one time  and any remaining balance will be billed to you.
• Check with your insurance that our office is in - network. Additional charges may be applied by your insurance if we are out - of - network.
• Please inform us of any changes in coverage, your address or phone number.
• Check if your insurance require s a re ferral from your primary care doctor to see us to receive the maximum benefit of your insurance.

• If your annual out of pocket expenses (deductible) have not been met, we may collect 10 0% of the visit’s charges on the day of your appointment . This will be applied to you r account and a statement will be sent reflecting any additional monies owed and a response from your insurance carrier. 

Fees We accept check, Visa or MasterCard. We will make all reasonable attempts to collect outstanding balances, including convenient payment arrangements.

- Balances not received within 30 days from receipt of your billing statement will be charged $35. After 3 attempts, your account will be sent to a collection agency and additional fees will be added at their price. 

- Returned checks: $20.

- Late Cancellation/No-Show We understand cancellations may happen from time to time. In order to be respectful to other patients requiring medical attention, please call to cancel or reschedule promptly.

- Appointments cancelled within 24 hours or you do not show at your appointment (no-show) will be charged $50. Your insurance will not pay for this. Repeated no-shows may result in your care being transferred elsewhere.

- Surgery cancellation made within 10 days of scheduled date: $200.

- Forms/Letters Allow 7-10 days upon your request to be completed. This includes short-term disability forms for our surgical patients. Long-term issues should be addressed with your primary care doctor. Disability forms or other requested documentation: $15 each.

- Medical Records Per HIPAA guidelines, copies of your medical records need to be requested in writing using our Consent to Release Medical Records form. The first set by email is free of charge. Paper copies will have a fee of a minimum of $10.

Insurance Release The entirety of the above information is true to the best of your knowledge. You, the patient or guardian, authorize use of your insurance benefits to be paid directly to Pacific Point Podiatry and to use your signature below on all insurance submissions required to process claims.

Uses and Disclosures of Health Information Dr. Tea Nguyen, DPM will use and disclose your health information in order to treat you or to assist other health care providers in treating you. We will also use and disclose your health information in order to obtain payment for our services or to allow insurance companies to process insurance claims for services rendered to you by us or other health care providers. Finally, we may disclose your health information for certain limited operational activities such as quality assessment, licensing, accreditation and training of students.

Uses and Disclosures Based on Your Authorization Except as stated in more detail in the Notice of Privacy Practices, we will not use or disclose your health information without your written authorization.

• Uses and Disclosures Not Requiring Your Authorization In the following circumstances, we may disclose your
• your health care; • For certain limited re search purposes; • To the FDA to report product defects or incidents; • For purposes of public health and safety; • To authorities to prevent child abuse or domestic violence; • To law enforcement authorities to protect public safety or to assist in appreh ending criminal offenders; • When required by court orders, search warrants, subpoenas and as otherwise required by the law.

• Patient Rights
• information; • To receive an accounting of certain disclosures we have made of your health information; • To request restrictions as to how your health information is used or disclosed; • To request that we communicate with you in confidence; • To request that we amend your health information; • To receive notice of our privacy practices.

If you have a question, concern or complaint regarding our privacy practices, please feel free to contact us.

Thank you for your understanding and cooperation. We are delighted to serve you.