Uninsured Services List and Information – As of December 14, 2022
Policy on ‘Outside Use’ – As of January 10, 2023
Missed appointments
Patients are expected to inform our clinic at least 24 hours in advance if they cannot attend a scheduled appointment (virtual or on-site). This is best done through our phone line (extension 3). Otherwise, Essential MD Clinic will charge a penalty (see Uninsured Services for pricing). Please inform the clinic of an exceptional circumstances for last-minute cancellations as well as any financial barriers to paying the penalty.
Patient Third-Party Forms
When requesting your physician to complete a third party form, bear in mind that your healthcare provider will use objective information in the medical record. They cannot guarantee any outcome of the form and are limited by the completeness including legibility of records. Having a longer therapeutic relationship with the provider completing the form along with easily accessible medical records can make the task easier. See policy on Uninsured Services for more details and pricing. If there are circumstances that require additional work to complete the form, there may be additional charges involved (appointment to gather information, perform physical exam).
It is the patient’s responsibility to be aware of fees and let your healthcare provider know in
advance if there may be issues with paying the fee. The fee is ONLY FOR completion of the form
by your provider with the information they have – it will not be refunded if the desired outcome of
the form is not attained.
You can reduce possible additional fees associated with the form by reducing the work your healthcare
provider and their staff have in several ways:
- Ensure the form is brought to the clinic’s attention through the appropriate channel. You may
personally bring it to the office or have a third-party send it by mail or fax. Forms are not
appropriate for e-mail, patient messaging systems, or our secure drop-box.
- Please ensure your form has your signature and date. Please pre-fill the sections you are
responsible for. You may leave a note or partially complete sections within reason to give your
provider context for the form.
- Discuss with our administrative staff ahead of time if there are additional things needed for your
form such as an appointment to discuss with your provider, a physical exam, or records that may
not already be in your chart.