Office Policies

Policies, Procedures and Authorization Requirements

Insurance Co-pays/Deductibles/Coinsurance
It is the patient’s responsibility to provide the clinic with the correct insurance information, any balances incurred due to invalid insurance will be the patient’s responsibility. Insurance co-pays are due at the time the patient checks in for their appointment. If the patient does not have their co-pay at the time of check in the patient may be asked to reschedule their appointment. Any deductible and/or coinsurance amounts will be due after insurance has processed your claim. Please be aware your co-pay covers the office visit and physician services only. The patient could receive additional billing for laboratory testing done in the office. Any balances that are not paid in full or actively on a payment plan after 3 statements will be sent to collections. There will be a $30 fee for any returned checks and the patient will be required to pay with cash or use a credit card for any future payments. Failure to repay the returned check and the return check fee may also result in collection proceedings.

Referrals/Laboratory
If the patient’s insurance requires a referral from their primary care provider the patient will need to present this at their first visit. If the patients insurance requires the use of a specific laboratory, the patient must inform the staff immediately. Urogynecology of Kansas City will not be responsible for specimens sent to the wrong laboratory. Urogynecology of Kansas City will handle any prior authorizations for hospital or office procedures (e.g. urodynamics, cystoscopy, etc.). If you have questions about your insurance, we are happy to help you. Specific coverage issues, however, should be directed to your insurance company member services department (the number is located on your insurance card). It is your responsibility to know what is and is not covered by your insurance and to be responsible for the expense of treatment not paid and/or covered by your insurance.

Appointments
It is the patient’s responsibility to keep track of appointment dates and times. We respect your time and run our office on schedule. To do this, we do NOT double book appointments. If you are unable to make your appointment, kindly provide 48 hours notice to avoid a cancellation fee. The fee is equal to the visit type that you have scheduled, which generally ranges from $100- $250. We ask all of our patients to arrive 15 minutes before their scheduled appointments in order to ensure timely visits for all of our patients. This is particularly true for new patient visits which may require a full hour. If you are greater than 15 minutes late we ask that you reschedule your appointment in order to ensure that you receive the best care possible.

Medical Records
Please allow 7-10 business days from the date you turn in your signed Medical Record Release form for your medical records request to be complete. We will transfer records to another physician at no charge. If you would like a copy of your records there is a fee as outlined below by Kansas Statute (K.S.A. 65-49719(b)).

• Cost of Supplies & Labor – $18.97
• First 250 pages – $0.63
• Additional pages – $0.45

Disability, Insurance or Employment forms
Urogynecolgy of Kansas City will prepare the necessary forms supplied by the patient that are required by insurance companies or employers. These forms are often quite detailed and lengthy and therefore cannot be completed quickly. Urogynecolgy of Kansas City requests that the patient leave the forms at our office for completion with all information that the patient can provide already filled in. Our staff will then complete the forms within 7-10 business days. There will a $20 fee for each set of forms.