Mobile. Affordable. No Insurance.
 
Kara Diersing Clapp, PhD, APRN
Family Nurse Practitioner
Tuesday, April 25, 2017
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Doctor Kara, PC
PO Box 901020
Sandy, Utah 84090-1026
Voice: (801) 495-9303
 

Appointment Policy

Our clinic makes every effort to help you keep your appointment with email reminders 3 days in advance of your appointment and the day before your appointment. However, we recognize that there are times when the world seems to be against us and we are going to be late or miss an appointment altogether. Unfortunately, the time you schedule is yours, and yours alone and cannot be given to another patient. We never double or triple books appointments. Nobody else will ever have an appointment that overlaps your time in any way. Due to the nature of our medical services, we do not have a return or refund available to the customer.

To ensure that our clinic will always be able to provide the famous “No Wait Guarantee” and affordable pricing for cash-pay patients, the following conditions apply:

  • There is a one-time forgiveness for failing to show for your reserved appointment time (No Show Fee still applicable). 
  • You will be asked to seek another health care provider on a second failure to keep your reserved appointment.
  • Policies are subject to change without prior written notice.
  • Your credit card will be charged $1 reservation fee at the time you schedule an appointment by computer or by phone. If you request a rescheduling, the fee is $25. Failure to show for an appointment or cancelling less than 3 business days in advance will result in a charge for the full appointment. The charge is based on the cash pay rate for the length of the appointment reserved.
  • Appointment fees are to reduce the financial loss incurred by Doctor Kara PC, as we do not double or triple book appointments. Your appointment is yours and your only.

Cancellations can be handled through the online scheduler. You may also call Doctor Kara, P.C. at 801-495-9303 (preferred method). 

Late Arrival Clause:

  • A patient will only be seen for the remaining time of the appointment and may have to schedule a second visit to complete any unfinished business.
  • A patient will be responsible for the cash-pay rate of $4/minute for the tardiness and the missed service that cannot be billed to insurance.
  • A patient will be asked to reschedule for another appointment if tardy by 10 minutes or more. Our office clock is used as the official clock, as it is an atomic clock.

 

Billing Policy

Patients Acknowledge:
  • All insured patients are responsible for :  (a) all co-pays and payments toward unmet deductibles, (b) any administrative fees and all medical charges regardless of decisions made by my insurance plan. Due to the nature of submitting claims to insurance plans and delays in payment, any finance charge and invoicing fee will be retroactive to the date of service.
  •  Insured patients are responsible for providing accurate insurance information at the time of service, including proof of insurance coverage. Any insured patient who fails to provide an insurance card will be treated as a cash pay patient and is subject to cash pay rates at the time services are rendered. If you submit a valid card after you have been processed as a cash pay patient, you will incur a $25 fee for reversing previous bookkeeping entries.
  •  Invoicing fee: $10.00 per invoice to cover postage and time spent generating a paper  invoice. Electronic invoicing is free of charge. You must provide valid email address to qualify for electronic invoicing. Any failure to respond to an electronic invoice will trigger a default to paper invoicing.
  • The annual finance charge of 18% will be applied to the unpaid account balance (1.5% per month).
  • Once the unpaid account balance reaches 30 days maturation from the date of service, the account will be turned over to small claims court or a collection agency, unless special arrangements have been made with Doctor Kara PC for installment payments on overdue balances.
  • In the event legal action is taken to collect on the account, an additional amount of 50% of the principal balance will be added to offset the costs of attorney’s fees, court costs, or collection agency actions. This additional amount is in recognition of the costs associated with collection action processing.
  • In the event Doctor Kara, P.C. is unable to obtain a valid payment I agree to pay an additional administrative fee of $15.00 per occurrence to offset the time and effort spent in notifying me of an invalid payment.
  • All communication and inquiries to Doctor Kara, P.C. about my account must be submitted in writing by the account holder (or executor of the estate in cases of a deceased account holder). Doctor Kara, P.C. will respond in writing within 7 calendar days, except during periods of extended absence. Office closure dates will be posted on the clinic website and the office entrance. I agree to notify the office in writing of any changes in my contact information (name, address, phone number, work number, etc). I hold Doctor Kara, P.C. blameless for lost communication in the event I fail to maintain accurate contact information with the office.
  • The information given in the registration form is valid and true to the best of my knowledge. I understand I am financially responsible for all office charges payable to Doctor Kara, PC. I also authorize Doctor Kara PC to release limited medical information to expedite the process of requesting lab or diagnostic tests and necessary medical referrals to other medical professionals during the course of my treatment.

Patients further acknowledge:

  • Patient is the authorized card holder of the credit card listed on the Patient Registration Form page 1.
  • The patient designates the credit card listed on thePatient Registration Form page 1 as the “credit card of record” for the account.
  • In the event the credit card of record is reported as lost or stolen, the patient will provide the clinic with new and valid credit card information as the credit card of record to maintain an account in good standing.
  • The patient authorizes the clinic to make charges against the credit card of record in accordance to the terms and conditions listed in the billing policy, appointment policy, or any other special contracts the patient holds with the clinic (i.e. VIP membership).
  • The patient is responsible for maintaining accurate and valid payment information with the clinic to facilitate valid payment for medical services requested and/or received.
  • In the event we are unable to obtain a valid payment, using the credit card of record, the patient agrees to pay an additional administrative fee of $15.00 per occurrence.
  • Credit refunds will only be made to the credit card of record within 3 business days. Cash refunds cannot be issued against accounts paid with credit cards.
  • The patient acknowledges that if he or she misrepresents personal and financial facts to the clinic in order to obtain medical services under false pretenses or to avoid paying valid charges payable to the clinic, those misrepresentations may be construed as probable fraud. In cases of probable fraud, the clinic may:
    • File a theft report with the appropriate authorities
    • Provide all appropriate supporting documents and information regarding the fraudulent activity to investigating authorities
    • Immediately refer to a collection agency for legal action through Small Claims Court in the event of any fradulent activity
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