Office Policy
1. All payments, including outstanding balances and copayments, are due at the time of the visit.
2. A No-Show fee of $75 or a same-day cancellation fee of $50 will be charged for missed appointments or appointments canceled on the day of the scheduled visit.
3. All Prior Authorizations (PA) processed by this office will incur an administrative fee of $15.00 per PA completed by us, irrespective of the outcome. We cannot guarantee approval, and the responsibility for any necessary appeals rests with the patient. This office will only process PAs for brand-name weight loss medications that lack a generic alternative.
4. All abnormal test results must be discussed with Dr. Chandra in person before being released on the patient portal. We do not discuss any test results via telephone or email correspondence.
5. A returned check will incur a fee of $30. We do not accept post-dated checks.
6. Any outstanding balance(s) not paid within 30 days of the statement date will be charged a late fee of 5% every month; and after three (3) months, the account will be sent to a collection agency and charged an additional 35%. The patient will be responsible for all associated legal costs.
7. Medication refills require a minimum of 3 business days for completion. All controlled medications will be prescribed for a maximum of 30 days without refills. No refill for weight loss medication will be done if the patient has not been seen within the last 1 month.
8. The patient consents to telehealth services for both initial and ongoing weight loss consultations. It is the patient’s responsibility to ensure access to a laptop, PC, or mobile device, and a reliable internet connection for an effective telehealth consultation. No consultations will be conducted via telephone. Consultations will be canceled or terminated if the patient is operating a motor vehicle or is otherwise distracted.
9. Patients are provided free access to our secure online portal to view and print select portions of their medical records. Requests for a comprehensive print-out of medical records must be submitted in writing. We offer complimentary transfers of medical records to other healthcare providers via our HIPAA-compliant EHR system. If you require personal copies to be mailed, they will be sent exclusively via certified mail. Please allow 3–4 business days for processing. A retrieval and mailing fee applies to all physical copy requests. The cost is $1 per page, capped at a maximum of $100.00 for the entire record.
10. It is the patient's responsibility to provide this office with accurate demographic and insurance information. Any denial of coverage by the insurance company due to incorrect information or lack of active coverage is the patient's responsibility. A 15% financial charge will be added to the resulting balance.
11.A patient will be discharged from the practice for the following reasons:
A. Exhibiting disrespectful, threatening, or abusive behavior toward JMWL staff.
B. Refusing to adhere to our office policy.
C. Failing to pay the outstanding balance or having an account in collections.
I have read and fully understand this policy. The preceding terms are acceptable to me.