This office policy describes some of our common business practices and is meant to be easy to read. If you have any comments or questions, please call our office or send us an e-mail with your suggestions for improvement of clarification to email@example.com.
01. Notice of Privacy Practices
The Notice of Privacy Practices is a separate document that is published on the website of the practice.
02. Payment authorization
Bernhard Zunkeler, M.D., P.A., may release patient medical and other information to any insurance company that pays the health-care costs of the patient.
The patient authorizes Bernhard Zunkeler, M.D., P.A., to contact health insurance companies to verify benefits; to use electronic online databases to verify patient identity; to check insurance or pharmacy benefits; to obtain past prescription drug usage by the patient; and to access public online judicial and other internet records to make determinations regarding the start, continuation, or termination of a future or existing patient-physician relationship and to supplement and verify the information provided by the patient.
The patient authorizes payment directly to Bernhard Zunkeler, M.D., P.A., for surgical or medical services that might otherwise be payable to the patient. The patient is financially responsible to Bernhard Zunkeler, M.D., P.A., for any charges not covered or paid in full by the patient’s health insurance company. In the event that Bernhard Zunkeler, M.D., P.A., is a participating provider with the health insurance company, the contract of the health insurance plan will determine how much money the patient owes Bernhard Zunkeler, M.D., P.A.
Payment for co-pays, deductibles, or other amounts of money considered by the insurance company to be the patient responsibility is due at the time of service. Late payment may result in additional charges, including collection charges (see below).
03. Patient-physician relationship
A “patient-physician treatment relationship” begins when the patient and Dr. Zünkeler meet in Dr. Zünkeler’s examination room or via telemedicine video with the mutual intention of starting a patient-physician treatment relationship. A patient may terminate the patient-physician treatment relationship with Dr. Zünkeler at any time and for any reason. Dr. Zünkeler likewise reserves the right to withdraw as the patient’s health-care provider.
Dr. Zünkeler encourages his patients to obtain second opinions regarding their medical conditions but requests a copy of the other treating provider’s note to remain fully informed.
Dr. Zünkeler infrequently prescribes narcotic (opioid) medications because they are usually not well-suited for the treatment of chronic pain disorders and because their long-term side effects outweigh their short-term benefits. If Dr. Zünkeler decides that narcotic (opioid) medications offer a potential treatment advantage for a patient, an opioid contract may need to be signed. If the opioid contract is breached, Dr. Zünkeler may discharge the patient from follow-up for noncompliance. Dr. Zünkeler may check online databases (i.e. Surescripts or CRISP) to confirm compliance with the opioid contract.
If the patient-physician treatment relationship between the patient and Dr. Zünkeler is scheduled to end or has already ended, Dr. Zünkeler will be glad to provide the names of other neurosurgeons and spine care providers in the Baltimore area. The patient will remain obligated to pay for services rendered before termination of the physician-patient treatment relationship.
04. Copies of clinical notes and records
It is a patient’s right to request and be provided with a paper copy of his or her medical records. In addition, with the patient’s written authorization for release of information, we will provide his or her attorney and insurance company with copies of the patient’s medical records. A statutory copy fee applies in the State of Maryland. The medical record copy charges set by the State of Maryland are 76 cents per page (as of April 2020) and are periodically inflation-adjusted. Postage costs and a record preparation fee of $22.88 will be included in the charge for records supplied to attorneys and insurance companies.
Patients may also gain access to some of their health information and test results through Dr. Zünkeler’s web portal.
05. Medical disability forms and other certifications
There is no additional charge for medical work or school release certifications (“work slips”). Please note that Dr. Zünkeler will not extend any work release retroactively (i.e. before the patient was seen by Dr. Zünkeler) and will not cover any gaps in the patient’s medical work release that are due to the patient’s failure to show up for the scheduled follow-up appointment (which coincides with the end of the prior medical work release).
The fee for completing most forms is $15 for one page and $5.00 for each additional page, payable when the patient picks up the forms from our office. Alternatively, a patient may send the forms along with payment and a stamped, self-addressed envelope to our office. Please allow 3-4 business days for forms to be completed. If the forms need to be sent directly to a third party, a written release authorization allowing Dr. Zünkeler’s staff to mail or fax the information must be on file. If circumstances do not allow the patient to provide Dr. Zünkeler’s office with postage and addressed envelopes, a shipping and handling charge (i.e. the actual postage plus $7 per addressed envelope) will be due.
06. Late-cancellation/no-show policy
We may charge a late/no-show fee of $50 for appointments that are not kept and that are not canceled or rescheduled at least 48 business hours before the scheduled appointment time. We may not be able to see you in the office if you arrive more than 15 minutes after your scheduled appointment time.
07. Returned personal checks
We will charge $50 for each personal check returned due to “insufficient funds,” “account closed,” or similar reasons for nonpayment.
08. Unpaid balances
We will bill patients for unpaid balances.
09. Collection agency
When repeated requests for payment remain unanswered, we may use a collection agency to collect unpaid funds. Additional fees, including collection agency fees, attorney fees, and court costs, may also apply.