|
Woodlands Healing Research Center |
|
New
Patient Information |
|
Date: 06/26/2005 |
|
Click here to
Return to
Woodlands Home Page |
IMPORTANT-PLEASE READ THIS ENTIRE PAGE!
Keep Scrolling Down to the very bottom!!
|
Medical History Forms: |
|
|
Please choose the most appropriate form and
complete it prior to your visit. You
may complete it on-line, print it and bring to your visit. Alternatively,
you may print the form and complete it in ink and bring it to your visit. If you are being asked to spend your time
and effort completing this questionnaire, you deserve to know why we feel it is important. We believe in, and
attempt to provide you with, personal and thorough health care. While this requires knowledge of medicine and
compassion on our part, it also requires your participation and help.
Although the questionnaire is long, the information
is important; so please answer the questions as best you can. Furthermore, this questionnaire is organized to serve as a learning tool for you. Some patients prefer to answer one or two questions in person rather than on paper; we can do that if you wish. Some of the items may not apply to your particular situation; just omit those sections. You may skip any question you do not wish to answer or are unable to answer. After it is completed, we recommend that you make a copy of the questionnaire for your personal use. We understand that completing this form is time consuming but we feel your health is well worth it. |
|
| Adult New Patient Medical History Intake Form |
From ages
13+ years. This intake form is to be completed
before the first visit. Take note that the end of the questionnaire includes a 7-day diet diary. Be sure to give yourself as much time as possible before your appointment to complete this diet intake. If time is not available, it may be completed after the initial visit to then be reviewed at a later date. |
| Child New Patient Medical History Intake Form |
From ages
Newborn to 12 years. This intake form is to be completed before the first
visit for a problem oriented child visit.
Take note that the end of the questionnaire includes a 7-day diet diary. Be sure to give yourself as much time as possible before your appointment to complete this diet intake. If time is not available, it may be completed after the initial visit to then be reviewed at a later date. |
| Well Child New Patient Intake Form | From ages Newborn to 12 years. This intake form is to be completed before the first visit for a well child visit. |
|
Other Required Forms: |
|
| Please complete these forms on-line, then print it and bring to your visit. Alternatively, you may print the form and complete it in ink and bring it to your visit. Please sign forms requiring your signature. | |
|
Click on the links below to choose each form: |
|
| This forms
provides us with phone, address, insurance information, emergency contacts,
pharmacy and other physicians, etc.
|
|
| This form
is required by law for us to process your claims for services performed at
our office.
|
|
| This form
is mandatory by Federal Law to provide to you listing your
privacy rights concerning your medical information. Please print the
signature sheet that your received the notice, sign and bring to your office
visit.
|
|
| This form
is mandatory by Federal Law for you to give us permission on
how to communicate your health information to your and any others you
designate.
|
|
|
For
Medicare patients only. This form is mandatory by
Federal Law. Please complete and bring to the office @ your
visit.
|
|
IMPORTANT NEW PATIENT INFORMATION
PLEASE READ ALL OF THIS!
General Information:
To facilitate our helping you, we ask that you do the following:
· If you have been seeing other physicians, request copies of your medical records to include results of lab tests, EKG’s, x-rays, etc. These may be brought with you at the time of your appointment or you may request that they be mailed or faxed to our office. Medical release forms are available from our office and our address and fax are listed above. If you bring copies of medical records or tests, please inform our staff when you check in so that they may start copying and organizing the material for your chart.
· Please plan to arrive early for your scheduled appointment. Entering information in the computer, insurance verification, copying records, and check in takes time, which we prefer not to interfere with your scheduled time with the doctor. Late arrivals may result in the need to reschedule your appointment.
· Examination of the skin, hair and nails is an important part of a medical assessment. For your first visit, it is very important that you do not apply any make-up, nail polish, skin creams, hair sprays or hair gels until after your physical examination.
· Due to our patients with chemical sensitivities and the extensive allergy testing performed in our office, we require that you, your family members and guests NOT wear ANY perfumed products during ANY of your visits here.
· Should you need to cancel, we require twenty-four (24) hour notice.
Billing and Insurance
· Please bring your insurance card and information with you to your appointment.
· As insurances constantly change, you may call to verify which insurances we currently participate with.
· If we do not participate with your insurance, we require payment at the time medical services are given.
· Please see the next page for further information concerning insurance and medical necessity.
Laboratory Testing
· If you have a new appointment scheduled for the morning, we ask that you or your child try to come without eating or drinking anything for breakfast. In other words, we ask you to come after an overnight “fast”. You may drink water but no coffee, juice, soda or anything else. You may have a “before bed snack” if you desire. If you cannot perform this fast, that is OK. If you have an afternoon appointment scheduled after 1:30 PM please DO NOT FAST! We are not able to perform some tests late in the afternoon due to scheduled pick up times. Some problems require testing that requires fasting, other times however, this is not necessary. However, we cannot determine what, if any testing at all, needs to be done until we see you. Most of our patients prefer to have what testing is necessary at the first appointment, and if you come fasting this will greatly facilitate any testing needed. Again, this request is not mandatory and any person, for what ever reasons, who cannot fast we will make other arrangements as circumstances dictate.
· When possible, we try to check a urinalysis on all new patients. Please keep this in mind when you are seen for the first time at our facility.
· If you have insurance that requires testing to be performed at certain laboratories, please call your insurance company or the health benefits advisor of your employment establishment to determine which labs are considered “in network.” You should also ask if your insurance has any “out of network” provisions that allow you to use other laboratories. This is especially true of certain insurances like Devon and PHCS, which use a different lab depending on which particular policy you have. Since this information is unknown to us, it is your responsibility to know this information since any lab work done “out of network” will incur additional costs to you.
· Any lab testing performed is billed separately from the office visit. In other words, the office visit fee does not include any laboratory testing. This includes lab tests performed at our office and lab tests drawn at our office but sent to another lab to be performed. If the test is performed at our office, you or your insurance company will receive a bill at a later date after the test is performed and quality control determines that it is an accurate value. If the test is drawn at our facility but sent to an outside lab, you or your insurance company will receive a bill from that particular lab. We do not bill for what other laboratories perform.
· You always have the option to have any test performed at the laboratory of your choice. This means that you will receive a lab request form that you can take to the lab of your choice. We will do our best to accommodate your desires.
Allergy Skin Testing
· Allergy Skin testing is performed at our facility. However, it must be ordered by one of the doctors after a medical history and physical exam is obtained. To make testing as convenient as possible, we can arrange for skin testing to be performed immediately after your initial visit.
· If you think you might need allergy skin testing or if you were referred to us for allergy testing, you must call our allergy lab at 215-536-1700 during normal business hours to obtain pre-testing directions that include the avoidance of certain medications. This is very important since certain medications can interfere with allergy testing.
· If we participate with your insurance company we will submit the bill for allergy testing. If we do not participate with your insurance company, payment is expected at the time the service is provided.
Navigating the Health Insurance Maze
Insurance rules and regulations are often confusing, continuously changing, and are at the whim and fancies of employees of the individual insurance companies. The doctor and the patient essentially are running after a moving target. The situation is deliberately created to keep both the doctor and the patient confused; the desired end result is the creation of a “system” where the patient does not want anything done and the doctor does not want to do anything.
“Medical Necessity” vs. “Medical Appropriateness”
Many insurance companies define medical necessity as the following:
“The shortest, least expensive, or least intense level of testing, treatment, care or service rendered, or supply provided, as determined by “Insurance Company X” to the extent required to diagnose or treat an injury or sickness (not necessarily a symptom or syndrome). The service or supply must be consistent with the insured person’s medical condition, is known to be safe and effective by what most doctors think who are licensed to treat the condition at the time service is rendered, and not provided primarily for the convenience of the insured person or doctor.”
Medicare's (HCFA) Definition of Medical Necessity:
Paragraph 1862(a)(1)(A) in the Social Security Act defines reasonable and necessary those tests and procedures used in the diagnosis or management of illness or injury or to improve functioning in a malformed body part. Tests and procedures defined as experimental by the FDA or HCFA are not considered reasonable. FDA approval does not automatically mean medical necessity. Paragraph 1862(a)(7) excludes routine physical checkups from coverage. Some other tests, procedures, equipment, or devices are statutorily excluded as non-covered services, for example, cosmetic surgery.
Another Insurance Co:
“Not demonstrated through prevailing peer reviewed medical literature to be safe and effective for treating or diagnosing the condition or illness for which its use is proposed.”
As you can see from the above examples, insurance company’s arbitrary definition of medical necessity has absolutely nothing to do with “medical appropriateness.” The insurance definition of medical necessity is very clear that it does not appear to matter that a test or treatment will make a patient fell better or optimize their “wellness.” Medical necessity is a business decision whereas medical appropriateness is a medical decision that signifies optimal medical care. It is very important to understand that it is perfectly possible for a medical decision to be medically appropriate for you as an individual but not “medically necessary” as deemed by your insurance company. Medical appropriateness is governed by the Hippocratic Oath, which tells physicians to “use treatment to help the sick according to their ability and judgment, but never with a view to injury and wrongdoing.” The physician takes an oath to provide their best medical care, according to his or her ability and judgment, not according to randomly changing criteria set by bureaucrats, insurance companies and peer review organizations.
Woodlands will do all in its power to work with you and your insurance company towards meeting medical necessity guidelines and obtaining insurance coverage for your health care services. However, we take our duties and responsibilities outlined in the Hippocratic Oath very seriously. Our guiding goal of service to you is to provide optimal medical care that is governed by medical appropriateness, not arbitrary insurance “medical necessity.”
Consequently,
Your desire to reach optimal health and wellness is our main objective and we will do all that we can to accomplish this goal for you. Accordingly, we will do our best to help guide you through this very confusing maze of insurance rules and regulations governing coverage of your medical care.
Please feel free to call our office if you have any questions or concerns. In advance, we thank you for your cooperation and your extra efforts to help us help you.
|
|
With Warmest Regards, |
|
|
Rose Neuweiler, C.M.M., C.PC., Office Manager |
|
Click here to Return to
Woodlands Home Page |
A Healthy Approach In An Unhealthy World