Important Information

Important Information Please Read

 

 

It is our goal to provide you with the highest level of quality care.  At the same time, it is very important that patients know their responsibilities while receiving care.  The following topics provide valuable information needed for everyone to learn and understand about our policies that are inquired about every day.   

 

 

Cumberland Family Care, PC does not discriminate in the provision of services to individuals based on their inability to pay, race, color, sex, national origin, disability, religion, or sexual orientation. 

 

 

 

If you are uninsured and paying cash for your primary care medical visit, please let us know upon scheduling.

 

 

Discount/Sliding Fee Policy for Van Buren Clinic (RHC)

 

Discount/sliding fee schedule for office visits/charges at the Van Buren Clinic for uninsured patients

Cumberland Family Care, PC offers essential primary care medical services to uninsured patients regardless of the ability to pay. A discount/sliding fee schedule is available for medical services to all uninsured patients who establish care at this practice. Discounts only apply to services at this practice and do not include those which are purchased from outside sources (outside labs, inpatient/hospital, drugs, ancillary/diagnostic, etc.). The discount/sliding fee scale is calculated from the updated Federal Poverty Guidelines.

There are three applicable discounts for uninsured patients based upon the information provided on annual household income and the number of family members in the household. The Receptionist has current Annual Income Earnings and Sliding Fee Discount Chart to calculate your % discount based upon the information you provide. Patients may be asked at each visit if any income information has changed. Patients are responsible for informing the Receptionist of any changes in information or financial status at the time medical services are rendered. The discount/fee schedule % on routine office charges are as follows:

The following discounts % is applied to uninsured patients based upon financial income information provided at the time of the medical visit:

 

Table shows % discount on fees for patients based upon income/poverty level and household Poverty Level

≤ 100%

≤ 150%

≥ 151%

# Living in household

No Charge

Discount on Fees = 60%

Discount on Fees = 40%

1

$11,670 and below

$17,505

$17,506+

2

$15,730 and below

$23,595

$23,596+

3

$19,790 and below

$29,685

$29,686+

4

$23,850 and below

$35,775

$35,776+

5

$27,910 and below

$41,865

$41,866+

6

$31,970 and below

$47,955

$47,956+

7

$36,030 and below

$54,045

$54,046+

8 or more

$40,090 and below

$60,135

$60,136+

 

At this time, routine labs are billed from Lab Corp back to Cumberland Family Care, PC Van Buren, so a discount on such services may also be given at the same % listed above, however, payment is due at the time of lab is drawn. Otherwise, payment arrangements for discounted labs should be made in advance unless approved by the provider or in the event of an emergency.

NOTE: Uninsured patients who indicate household annual income at 100% poverty or below must complete a Financial Hardship Form in order for medical fees to be waived (provided at no charge). This form must be updated every six months OR when there is a change in the household income level, OR if the patient becomes insured.

Uninsured patients receiving any discount on fees, may for future medical visits, be asked to bring proof of annual household and income to Reception. Uninsured patients who do not wish to provide any financial information (verbally or written) on annual household and income will still receive a 40% discount on services if payment is made at the time of the service or other arrangements have been made.

Patients receiving discounted fees are expected to pay at the time medical services are rendered unless payment arrangements were made with Reception or Billing prior to the medical visit. However, in the event that arrangements

were not made and such payment may cause financial hardship, the patient may see Reception to have the owed balance divided up into reasonable monthly payments. The patient must be in "good standing" with their account in Billing. The patient is responsible to make reasonable payments in agreement with sound billing arrangements and company policies. The patient must remain in "good standing" with any outstanding or other balances, or make new arrangements with the Billing Department to receive future discounts for services. Patients who do not comply with this policy and all other policies at Cumberland Family Care, PC may no longer be eligible to receive discounts or waived fees until reinstated by the healthcare provider of the Practice Administrator.

Other discounts and payment arrangements for uninsured adult groups may be implemented as designated arrangements are made by the providers. Arrangement such as these are separate from this policy.

This policy may only apply to patients receiving primary care at the Van Buren Clinic location, 817 College Street, Spencer, TN 38585. Any questions regarding this, or any other policy, may be directed to the Practice Administrator at (931) 738-3383.

NOTE:

Effective 4/1/14, the Affordable Care Act required patients to have some type of insurance coverage for healthcare services or have the possibility of a tax penalty. Insurance and information can be obtained through the Health Insurance Marketplace online at www.healthcare.gov, or by calling 1-800-318-2596, local County Health Department, or a Certified Marketplace Navigator.

 

Revised: 11.01.14

 

Policy on Controlled Substance Prescriptions

 

We have changed our prescription drug POLICY for prescribing controlled substances (pain medication, sedatives, ADHD drugs, etc).  Compliance to this POLICY is mandatory.  It is improtant that you read and understand this policy, and agree to comply with it before any prescriptions for the above medication types will be written.  Your medical provider may require that you complete a risk assessment, sign a controlled substance agreement and/or submit urine drug screen at any time prior to prescribing such medications.  You may ask our Receptionist for the full copy of this policy.   

 

New Patients

New patients are currently accepted at both our Sparta and Spencer locations.  Please call 931-738-3383 and ask for the billing department for questions as to what insurance plans are currently being accepted.  Please call 931-946-2113 to schedule an appointment at the Van Buren office.

New patients should arrive 20 minutes prior to the scheduled appointment time.  This time is necessary to complete all required information.  You may also visit our Patient Forms page of this website in order to print and complete these forms before the appointment.  Please bring your insurance card, a photo ID, and a current list of medications and/or medication bottles with you in order for us to have accurate information in the computer system.

 

Our focus of care is family medicine.  We generally (by physician approval only) do not provide services for managing chronic pain.  Patients needing this type of care should make arrangements at a medical facility specializing in this area.


All Patients
Patients should arrive at least 15 minutes prior to their scheduled appointment time.
  Patients arriving 15 minutes late for their scheduled appointment may be asked to reschedule.

Commitment to Your Appointment
We are happy to reschedule an appointment that must be canceled.
  However, in the event that an appointment must be canceled, it must be done by phone or in person no later than 1 hour prior to the scheduled appointment time.  Missed appointments with no notice of cancellation results in disruptions of another patient's schedule and limits the opportunity for others who need a medical appointment.  This may result in a $10.00 rescheduling fee.  Future appointments will not be scheduled until the fee is paid.  Three missed appointments in a 12 month time period without proper notice of cancellation may result in discharge from the practice.

 

If you unable to schedule with your primary provider at the time you wish to be seen, our receptionist will offer available appointments with other Cumberland Family Care providers. We also have a second facility in Spencer to serve your needs.  (See Our Providers website page for all the members of our team).

 

You may call to request your medication refill or come by and complete a medication refill form.  Calls and forms are routed to the clinical staff.  You may need an appointment to be seen prior to your medication being refilled.  If you need an appointment to be seen you will be contacted by our staff.

 

All CFC patients, age 2 and older, will be asked to have their photo placed confidentially into their medical record.  This is solely for the purpose of identity theft protection.  You have the right not to have your photo in the record if you so choose.  Simply let the front reception know when you are asked.  Updated photos are taken every two years.  Note: For your protection, if your photo is not in your medical record you may be asked to provide another type of photo identification at check-in. 

Insurance Information
It is your responsibility to provide new insurance plan information (or any changes with your insurance carrier) to Reception at the time of check-in.
Co-payments are due at the time medical services are rendered.  If your insurance plan requires a co-payment, this is not a billable fee and must be paid at each office visit.

Deductibles are a financial portion of many insurance plans that the patient must pay until they meet the individual carriers limit.  If your deductible has not been met after billing your insurance company a statement with the balance due will be mailed to you for payment.  Balances are due within 30 day following receipt of the statement.  If you have questions regarding deductibles, your balance, billing statement, or office charges, please feel free to contact our Billing office at 931-738-3383.


For those patients who have an assigned PCP (Primary Care Physician assigned with your insurance) that is not currently a provider with Cumberland Family Care, please note this needs to be changed prior to your appointment.  If the PCP has not been changed you may be asked to reschedule your appointment to a later date.  This must be changed by you with your insurance carrier.  The phone number is usually located on the back of the insurance card.

 

Patients with extended overdue balances may be turned over to a collection agency.  It is our policy that accounts turned over to collections will be assessed an additional fee. In addition these accounts are subject to discharge.  Please contact the Billing office if you have received a "final notice" letter.

Physical Exams

Patients are often confused on the various types of physical exams offered and whether or not they are covered by insurance.  While insurance plans vary in coverage, we are providing basic information.  Always contact your insurance carrier if you have questions regarding your plan coverage.  

Routine annual physical exams-- Preventative routine physical exams can be covered by insurances who provide "wellness" coverage.  These exams are thorough in length and can include immunizations in well child exams under certain insurance plans.  

School physicals--  These physicals are usually required for entrance into college and/or specialty schools.  These exams are not for grades K-12.  These exams are commonly not covered by an insurance carrier and are cash pay for the patient.  

Sports physicals-- Sports physicals are not commonly covered by an insurance carrier and are cash pay for the patient.  Check with your local school or coach for sports physical discounts offered.  

DOT physicals-- These physicals are required by the Tennessee Department of Transportation in order to receive a Commercial Drivers License.  These exams are not commonly covered by any insurance carrier or the employer and are cash pay for the patient.

REMEMBER...it is your responsibility to know your insurance plan coverage, your co-pay amount and/or deductibles.