OFFICE POLICIES
We welcome you as a patient in our practice. We pride ourselves in delivering the best urological care that can be found. Although we work as a team, we always strive to maintain the cherished patient/single physician relationship.

CONTACT US
At Bay Urology, our entire staff is highly qualified to deliver the best possible patient care. Please contact us with any questions that you may have regarding urological health, insurance questions or to schedule an appointment. We have three office locations to provide urological care and to meet your needs.

APPOINTMENTS
We usually see patients on an appointment basis. This is convenient for both patients and our staff. However, if you have a special situation, and you have to be seen, please call us and we will attempt to accommodate you as best as we can. Sometimes, unforeseen surgical situations arise that could delay an appointment and you may have to wait in our office to be seen, but we do our best to inform you of any delays. If you are unable to keep an appointment, please let us know so that we may modify our schedule and accommodate other patients. Please be sure to make special arrangements should ;you reside in a skilled nursing facility. We request either a family member or care giver accompany you to your visit.

TELEPHONE CALLS
Routine telephone calls:
We encourage you to call us with any questions that you may have. Our telephone operators are available to answer your routine calls from 8 a.m. until 4:45 p.m. Monday through Thursday, and 8:30 a.m. until 12:00 p.m. Fridays. Our office staff has been trained to answer many of your questions. They can:

• make an appointment
• change your appointment
• arrange for in office procedure
• arrange for in hospital procedure
• any other questions you may have

If they cannot answer your questions, they will relay your message to our doctors and they will call you back and speak with you.

Emergency telephone calls (evenings and weekends):
Please call us with non-urgent matters doing routine working hours. However if you have a true emergency please call us and the answering service will answer your call and connect you to our doctor on call immediately.
Let us emphasize that you should not hesitate to call our office with your questions and concerns. They are important.

EMERGENCY
In the event of life threatening emergency, please go immediately to the nearest emergency room and ask them to contact us. If the situation is not that severe, but one in which you would like to call us, please call our office telephone at 727-449-2298 and our answering service will ask you few pertinent questions (your name and a callback telephone number). Doctor on call will call you back promptly.

FEES AND PAYMENT
We have set our fees at a reasonable level based on community standards. If you have questions about our fees please feel free to call our billing department. You can help keep down the cost of your medical care by paying upon completion of each visit. All co-pays and deductibles are to be paid at the time of your visit. Sending statements increases our costs and fees. In case of financial hardship, and special circumstances, an arrangement can be made with our office manager.

COPAYMENTS
Copayments are due at the time of your visit. You also may be asked to pay for services not covered by insurance and if there are any deductibles. Please bring cash, check or major credit card. We accept Visa, MasterCard, American Express and Discover.

ITEMIZED STATEMENTS
Every time new charges are incurred, you will receive an itemized statement for those charges. Only one itemized statement is sent for each service.

Returned check due to NSF:
There is $25.00 fee on all returned checks and only cash shall be accepted for check fee, plus all further payments.

OVER DUE ACCOUNTS
Statements are sent monthly. If you are experiencing a financial hardship, please contact our billing department immediately to discuss payment arrangements. Unless overdue payment arrangements have been made, overdue accounts may be released to an outside collection agency.

Patients with no insurance coverage will be asked to make payment at the time of service, unless other specific arrangements have been made with our office manager.

MEDICARE
We are a "medicare participating" provider. We accept what medicare approves. They pay at 80% of the approved amount and 20% is patient's responsibility unless and until secondary insurance pays in full. If you have a secondary insurance we will bill them for the co-insurance and deductible. We are also required by law to collect from the patient any co-insurance due and any unsatisfied deductible. Any/all medicare non-cevered charges will be brought to your attention prior to being performed. We will have the cost available and require your signing a form accepting liability (ABN - Advanced Beneficiary Notice).

MEDICARE HMO
Many Medicare beneficiaries are changing their insurance from traditional medicare care to a Medicare HMO. If you have changed to a Medicare HMO, please remember to obtain a referral from your primary care physician prior to your visit. If you do not have a written referral, you will be asked to sign a waiver and will be responsible for the charges incurred for that visit. It is your responsibility to obtain a referral from the primary care physician. Please also provide our staff with a Medicare HMO card NOT the Medicare Social Security card so that we may bill the proper insurance.

PRIVATE INSURANCE/HMO/PPO
We participate in most of the plans that are available in West Florida. We will file an insurance claims for all services provided to you. However, please remember the responsibility for payment of fees is the direct obligation of the patient. If not payment or a rejection notice has been received within 30 days from the date of filing, we suggest that you should contact your insurance company about the delay. Please remember to obtain a referral from your PCP if you have an HMO insurance. Should you have any questions, please contact our billing department at 727-449-2298

We participate with most insurance companies in West Florida. To see the list of insurance companies, please click here.

ANY QUESTIONS REGARDING YOUR BILL PLEASE CALL OUR BILLING DEPARTMENT AT 727-449-2298

REFERRALS
Many of our patients are referred to us by other physicians. It is a very important that you first obtain a referral from your primary care physician before making an appointment with our office. Many HMO insurance plans require referrals from the patient's primary care physician before we may provide any service.

WHAT DO WE BILL FOR?

• Office visits and office consultation
• Surgical Procedure If you are scheduled for a surgical procedure, either in the office or in the hospital, we will bill your insurance company directly.
• Inpatient Hospital Charges
• Laboratory charges may be billed
• Ultrasonography Charges
• Our office will bill for all ultrasound procedures performed in our office

YOUR FIRST VISIT
Thank you for choosing Bay Urology. After making your first appointment, you will receive a welcome packet in the mail, which will include information about our practice, a map to our office, a demographic questionnaire, and health history form. Please fill out these forms at home before coming for your appointment.

WHAT TO BRING TO YOUR APPOINTMENT

• Your Insurance Card
• I.D., your Driver’s license
• List of current prescriptions including dose and frequency
• All over the counter medications
• Pertinent information about your medical, surgical and urological history
• Any urology records
• Any recent x-rays or laboratory reports

We are hoping that your experience at our office is a pleasant one. If you have any issues or need any extra assistance, please do not hesitate to call our administrator, 727-449-2298

FOLLOW-UP VISITS
When you arrive for you appointment each time we will verify your demographic information and insurance. We will also request that you update your signature on a yearly basis. Please be prepared to show your insurance card and driver’s license every time you are seen. We must verify you insurance numbers and keep a current copy of the card on file. Please let us know if there are any changes in:

• Medications/Allergies (bring with you current list of all your medications)
• Any new illness
• Any recent surgery
• Your address
• Primary Care Physician

PRESCRIPTION REFILLS
We prefer that you ask for prescription refills during your normal office visit. However, if you need a prescription refilled prior to a visit please call us. Refill requests by telephone will be fulfilled during office hours and will require 48 hour turnaround time in order for your request to be processed. The most efficient way is to have your medication refilled is to call your pharmacy and request that they call us. We cannot fill narcotic prescriptions during evening and weekend hours. If you have not been seen in the last 10 to 12 months we will not refill any prescriptions. You must be seen and evaluated. When you call, be prepared to provide our staff with:

• Your name
• Your telephone number
• Your birthday
• The name and spelling of the medication
• Pharmacy name and Telephone number
• It is also helpful to have the actual medication bottle on hand when you call our office.

NEW PRESCRIPTIONS
We are unable to keep up with ever changing formularies offered by different insurance plans. If your mail order pharmacy calls to alert us that prescription we wrote is not covered by particular insurance plan, we will substitute the formulary approved drug.

MEDICAL RECORDS REQUESTS
We are happy to provide you with copies of your records at the rate of $1.00/page for the first 20 pages, $0.25 each for additional copies.
We are limited by the HIPPA laws as to where and to whom we forward your medical records.
If you would like us to send your medical records to a physician other than the referring physician, you must request this in writing.
Your request to fax the records also has to be in writing.

LABS, X-RAYS AND PATHOLOGY RESULTS|
If you had a urine culture done in our office, we will call you with the results. If the culture is positive we will get the telephone number of your pharmacy and call in an antibiotic prescription for you.
If you had prostate or bladder biopsies done in our office, we will not call you with the results. We prefer to see you in person in our office to discuss the biopsy results. You also need to have urinalysis done at that visit to rule out urinary tract infection.

NOTICE OF PRIVACY PRACTICES
This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
Bay Urology respects your privacy. We understand that your personal health information is very sensitive. We will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to do so.
The law protects the privacy of the health information we create and obtain in providing our care and services to you. For example, your protected health information includes your symptoms, test results, diagnoses, treatment, health information from other providers, and billing and payment information relating to these services. Federal and state law allows us to use and disclose your protected health information for purposes of treatment and health care operations. State law requires us to get your authorization to disclose this information for payment purposes.
Examples of Use and Disclosures of Protected Health Information for Treatment, Payment, and Health Operations

For treatment:
Information obtained by a nurse, physician, or other member of our health care team will be recorded in your medical record and used to help decide what care may be right for you.

We may also provide information to others providing you care. This will help them stay informed about your care.

For payment:
We request payment from your health insurance plan. Health plans need information from us about your medical care. Information provided to health plans may include your diagnoses, procedures performed, or recommended care.

For health care operations:
We use your medical records to assess quality and improve services.

We may use and disclose medical records to review the qualifications and performance of our health care providers and to train our staff.

We may contact you to remind you about appointments and give you information about treatment alternatives or other health-related benefits and services with your permission.

We may use and disclose your information to conduct or arrange for services, including, medical quality review by your health plan; accounting, legal, risk management, and insurance services; audit functions, including fraud and abuse detection and compliance programs.

Your Health Information Rights
The health and billing records we create and store are the property of Bay Urology. The protected health information in it, however, generally belongs to you.

You have a right to:

• Receive, read, and ask questions about this Notice.
• Ask us to restrict certain uses and disclosures. You must deliver this request in writing to us. We are not required to grant the request. But we will comply with any request granted.
• Request and receive from us a paper copy of the most current Notice of Privacy Practices for Protected Health Information (“Notice”).
• Request that you be allowed to see and get a copy of your protected health information. You may make this request in writing. We have a form available for this type of request.
• Have us review a denial of access to your health information—except in certain circumstances.
• Ask us to change your health information. You may give us this request in writing. You may write a statement of disagreement if your request is denied. It will be stored in your medical record, and included with any release of your records.
• Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released. It also does not affect any action taken before we have it. Sometimes, you cannot cancel an authorization if its purpose was to obtain insurance.
  
  For help with these rights during normal business hours, please contact: 727-449-2298
  

Our Responsibilities:

We are required to

• Keep your protected health information private
• Give you this Notice
• Follow the terms of this Notice.

We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice. You may receive the most recent copy of this notice by calling and asking for it or by visiting our [office/medical records department] to pick one up.

To Ask for Help or Complain:

If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact: 727-449-2298

If you believe your privacy rights have been violated, you may discuss your concerns with any staff member. You may also deliver a written complaint to Bay Urology. You may also file a complaint with the U.S. Secretary of Health and Human Services.

We respect your right to file a complaint with us or with the U.S. Secretary of Health and Human Services. If you complain, we will not retaliate against you.

Other Disclosures and Uses of Protected Health Information:

Notification of Family and Others:
We may release health information about you to a friend or family member with written authorization, listing individuals by name.

You have the right to object to this use or disclosure of your information. If you object, we will not use or disclose it.

We may use and disclose your protected health information without your authorization as follows:

• With Medical Researchers if the research has been approved and has policies to protect the privacy of your health information. We may also share information with medical researchers preparing to conduct a research project.
• To Funeral Directors/Coroners:
  Consistent with applicable law to allow them to carry out their duties.
• To Organ Procurement Organizations (tissue donation and transplant) or persons who obtain, store, or transplant organs.
• To the Food and Drug Administration (FDA) relating to problems with food, supplements, and products.
• To Comply With Workers’ Compensation Laws if you make a workers’ compensation claim.
• For Public Health and Safety Purposes as Allowed or Required by Law:
  to prevent or reduce a serious, immediate threat to the health or safety of a person or the public.
• To public health or legal authorities
• To protect public health and safety
• To prevent or control disease, injury, or disability
• To report vital statistics such as births or deaths.
• To Report Suspected Abuse or Neglect to public authorities.
• To Correctional Institutions if you are in jail or prison, as necessary for your health and the health and safety of others.
• For Law Enforcement Purposes such as when we receive a subpoena, court order, or other legal process, or you are the victim of a crime.
• For Health and Safety Oversight Activities. For example, we may share health information with the Department of Health.
• For Disaster Relief Purposes. For example, we may share health information with disaster relief agencies to assist in notification of your condition to family or others.
• For Work-Related Conditions That Could Affect Employee Health. For example, an employer may ask us to assess health risks on a job site.
• To the Military Authorities of U.S. and Foreign Military Personnel. For example, the law may require us to provide information necessary to a military mission.
• In the Course of Judicial/Administrative Proceedings at your request, or as directed by a subpoena or court order.
• For Specialized Government Functions. For example, we may share information for national security purposes.
  

Other Uses and Disclosures of Protected Health Information:
Uses and disclosures not in this Notice will be made only as allowed or required by law or with your written authorization.

PATIENT BILL OF RIGHTS

YOUR RIGHTS AS A PATIENT - "Our commitment to you"

• You can expect to receive considerate and respectful care and service.
• You can expect to obtain complete and current information about your diagnosis, treatment and prognosis.
• You can expect to receive the information you need to give us informed consent before any treatment or procedure.
• You can refuse treatment to the extent permitted by law and receive information about the consequences of that action.
• You can expect every consideration for your privacy concerning your medical care.
• You can expect that all communications and records pertaining to your care will be treated as confidential; you have the right to
• Review your medical record and can request a copy of your medical information within a reasonable time frame and at a reasonable cost.
• You can expect to be involved in the planning and development of your treatment plan.
• You can request that the physicians speak with and/or involve key family members in your medical care and decision making.
• You can give or withhold consent to participate in research projects or procedures.
• You can expect to receive a full explanation of your bill, regardless of the source of payment.
• You can expect to know our expectations of your behavior and conduct.

YOUR RESPONSIBILITIES AS A PATIENT - "Your commitment to us"

• You are responsible to participate actively in decisions regarding your health care and to follow treatment plans that you and your physician establish.
• You are responsible to provide accurate, complete and timely information regarding your medical history, current symptoms and problems and other matters relating to your health.
• You are responsible to ask questions and seek clarification in order to understand and be informed about your diagnosis/treatment and what is expected from you.
• You are expected to be considerate and respectful of other patients, staff and physicians.
• You are expected to arrive on time for your appointments and/or notify us at least 24 hours in advance if an appointment can not be kept, failure may result in a $25.00 now show fee.
• You are expected to make timely payment for services provided. Elective procedures and co-payments are due at time of service; other balances within 30 days of the visit date or date of insurance payment, which ever is applicable.