Patient Guide
Fees
Your visit fee is based upon a number of factors such as..
- Time spent with you during your visit
- Complexity of your medical condition based on your presenting complaints, the type of exam performed, the type of diagnostic tests required to diagnose your problem, the time needed to research your condition, the time spent in consulting with other healthcare providers and the degree of difficulty in the decision making associated with your treatment plan
- Treatment types provided to you
Please understand that proper attention to your care also requires that your physician or members of PHP's staff, spend additional time beyond that which is spent with you in the office. Such time may be used to:
- Create or maintain your permanent medical record.
- Review, interpret, and document all lab test results and communicate those results-orally or in writing-to you.
- Review current X-ray or scan reports, compare them with reports of previous scans, and when the studies are abnormal, consult with the radiologist.
- Prepare and mail consultation reports and letters suggesting patients come in for a follow-up visit.
- Consult via phone about your case with referring or consulting physicians and other health care providers.
- Prepare referral letters to additional specialists, as needed.
- Prepare patient educational materials.
- Conduct medical research relevant to your case.
- Communicate with pharmacies about your prescriptions.
- Complete insurance claim forms and applications.
- Conduct utilization review negotiations with hospitals and insurance companies.
- Review and manage hospital records.
- Draft letters of medical necessity to obtain medical services, instruments, or prescriptions that you need.
- Arrange for hospital admissions and follow-up consultations with nurses, attending physicians, and house staff.
- Draft reports and forms, including home health care orders and nursing facility orders.
All of these activities add to our cost of delivering medical care.
Additional Fees
Below are some common tasks PHP performs everyday that may not be covered by your insurance plan. Consequently PHP may charge a small fee to partially cover the administrative cost of performing these tasks.
PHP follows the State of Texas Guidelines for Balance Billing for Health Care Services not paid by Insurance -- by Texas State Law.
- Consults and medical care with other physicians
- Phone consults initiated by patients
--Additional Time spent reviewing labs with patient on phone or e-mail - Medicine refills or changes handled outside of an office visit
- Referrals to Specialists, Physical Therapy, etc without an Office Visit
- Pre-authorizations for Medicines, Referrals, etc
- Forms for
- School
- Camp
- Day Care
- Kindergarten Care
- Elementary School through High School
- College & Post Grad School
- Sports Participation forms
- Disability Forms Completion
- Life insurance forms
- Patient Assistance Programs paperwork
- Insurance Company Summary Forms
- Family and Medical Leave Act (FMLA) Forms Completion
- Narrative Summaries for Lawyers and Insurance Companies
- Health and Life Insurance Forms & Information Requests
- Administrative Charges to cover increasing administrative costs from
--HIPAA, CLIA, DEA (maintaining and tracking of samples / supplies) - No-shows for Routine Visits & Physical Exams not cancelled within 24-hours prior of the appointment
- Surcharge for Co-payments not paid at the time of Office Visit
- Copies of Patient Charts, Medical Records, & Labs
PHP follows State of Texas DPHE guidelines for reasonable fees of health facilities
165.2. Medical Record Release and Charges.
- (e) Allowable Charges.
- (1) The physician responding to a request for such information shall be entitled to receive a reasonable, cost-based fee for providing the requested information. A reasonable fee shall be a charge of no more than $25 for the first twenty pages and $.50 per page for every copy thereafter. If an affidavit is requested, certifying that the information is a true and correct copy of the records, a reasonable fee of up to $15 may be charged for executing the affidavit. A physician may charge separate fees for medical and billing records requested. The fee may not include costs associated with searching for and retrieving the requested information.
- (2) A reasonable fee, shall include only the cost of:
- (a) copying, including the labor and cost of supplies for copying;
- (b) postage, when the individual has requested the copy or summary be mailed; &
- (c) preparing a summary of the records when appropriate.
Still, we are committed to providing you the best possible care at a reasonable cost. We hope this explanation of our fees has been helpful. If you have further questions, please feel free to contact our Practice Manager.
Prime Healthcare Providers is not responsible for the content of any linked site. See our Terms and Conditions.
