FORMS/BILLING We strive to make the patient experience as seamless as possible. One of the first steps as a new patient will be to familiarize yourself with our required forms. Please take a moment to review the forms below and if possible, complete and bring with you on your first visit. Having these forms completed when you arrive will help expedite your treatment and provide you more quality time with your physician. If you have any questions about these forms before your consultation, please don’t hesitate to call (334) 395-2200 or email us at info@carollc.com. New Patient Forms BILLING PROCESS MEDICAL RECORDS AUTHORIZATION NEW PATIENT WELCOME LETTER CONSENT TO PHOTOGRAPH & EMAIL PHYSICAL & HISTORY FORM HIPAA & PRIVACY NOTICE NOTICE OF PRIVACY PRACTICE FINANCIAL POLICY LANGUAGE NOTICE INSURANCE FORM Follow-Up Patient Forms PHYSICAL & HISTORY FORM BILLING PROCESS Insurance & Billing Thank you for choosing the Central Alabama Radiation Oncology, LLC for your health care services. The services provided by our Business Office staff are outlined below. Please take a moment to read them and, should you have any questions, you may call our Patient Accounts Representative at 334-395-2200. INSURANCE All new patients complete a patient information form and meet with a Patient Account Representative to verify insurance information. Central Alabama Radiology Oncology will help you with filing insurance claims, billing and contacting your insurance company. If it is necessary to provide pre-certification on imaging, we will assist in that process as well. When you register, you should bring all of your health insurance information. We will need identification, name of your insurance provider, group number and plan number. If your coverage is in your spouse’s name, we will need their date of birth. In addition, please bring your insurance card(s) so that we may photocopy it and put it in your file. So that we can help avoid any delays in receiving benefits, we will need to know which company is your primary carrier if you are covered by more than one insurance company. We will submit claims to your insurance carrier on your behalf. We participate in most insurance companies’ plans and accept Medicare assignment. If you have Medicare, you will be responsible for your 20% co-payment and the deductible for allowed charges. Please verify that our physicians are approved by your HMO or PPO plan if you participate in one. Please let us know if your plan requires pre-certification. On the first day of your first visit, please bring any referrals or pre-authorization that may be required by your insurance company. This may include office visits, hospital admissions, and treatment. If you need assistance with anything your insurance company requires, let us know and we will do our best to help. INFORMATION UPDATE You are responsible for updating any of your personal information that we have on file. This includes a change in insurance coverage and personal information. CO-PAYMENTS & DEDUCTIBLES Any co-payments or deductibles required by your insurance company will be due on the day of each visit. Some insurance companies require you to pay estimated coinsurance or deductibles, so please determine this before you meet with the Patient Account Representative. CLAIMS We will bill your healthcare services to your primary carrier and, if applicable, your secondary insurance provider. This includes Medicare and Medicaid. Health insurance varies from carrier to carrier. Please confirm your coverage prior to your first visit. SERVICES NOT COVERED BY INSURANCE Any medical services provided that your insurance company does not consider to be necessary will be payable at the time of service. You will be asked to sign a notice acknowledging that you are financially responsible for these services. STATEMENTS A statement outlining any remaining unpaid balances not covered by your insurance company will be sent. Typically the statements are sent approximately 45 days following treatment services. METHODS OF PAYMENT Balances may be paid with cash, check or credit card. We accept Visa, MasterCard and Discover. Payment is due within 15 days. PAYMENT PLANS Should you be unable to pay the full amount of your bill, we will assist you with a payment plan or applying for government sponsored programs. COLLECTIONS Any outstanding balance for which a payment plan has not been established will be due in 90 days. These accounts will be placed with a collection agency. FINANCIAL POLICY Our Financial Policy may be downloaded here. RIGHTS AND RESPONSIBILITIES Central Alabama Radiology Oncology will protect your rights, safety, and privacy. As your care provider, we will: Provide considerate and respectful care at all times and under all circumstances with special attention to your personal privacy and dignity. Provide complete information from our team about your illness, your course of treatment and the prospects for recovery in terms that you can understand. Allow you to exercise your legal and ethical rights to participate in treatment decisions. Provide information about risks and hazards of treatment, and alternatives to the proposed treatment before asking for consent. Cooperate, should you desire to seek a second opinion. Provide a reasonable response to your requests and needs under all circumstances. Always make your medical records available to you. If requested, provide treatment and services that you request within the applicable law and regulation. Correct any potential inaccuracies in your medical record. Inform you of any experimental treatment we might propose to use, how it might affect your care and your right to refuse such treatment. Respect your wishes to refuse any treatment. Refusing treatment at the end of life can be accomplished by preparing an Advance Directive (Living Will) in accordance with applicable laws, and providing a copy to your doctor. For us to provide you with the best possible care, we need your help also. Please keep in mind the following: Please be on time for your appointments and try to give advance notice if you cannot keep your appointment. Make sure that the information we have in your medical history is complete and accurate. Also, should you not clearly understand your treatment plan, please give us the opportunity to explain it to you. Once your treatment plan is complete, you should follow it. Please take other patients’ and guests’ comfort in our facility into consideration. Be considerate concerning food, visitors and children. Please fulfill your financial obligations in a timely manner. HIPAA/PRIVACY THE ONLY ACCREDITED FACILITY IN CENTRAL ALABAMA RESOURCES PATIENT INFORMATION – NEWLY DIAGNOSED – COMMON CANCER TYPES – RADIATION TREATMENTS BLOG HELPFUL LINKS FAQ’S ABOUT US OUR TEAM – DOCTORS – NURSES – THERAPISTS OUR FACILITIES OUR TECHNOLOGY TESTIMONIALS © 2021 | Website Design by 24 Communications Email Facebook Instagram LinkedIn