Premier Medical is committed to providing you with the best possible care and can discuss our professional fees with you at any time. It is important to our patient physician relationship that you read and fully understand our financial policy. Please let us know if you have any questions about your financial responsibility.
New patients are required to complete patient registration documents and medical history form prior to seeing the physician. Established patients are required to update their information forms at least once a year. We will ask to see your insurance card and driver’s license on every visit and will scan your card into our system as needed to keep our information current. Patients are required to pay Copayments/Deductibles upon completion of their visit. You can make your payment with cash, check or by Credit Card.
Your insurance requires that we collect your designated co-pay and/or deductible at the time of service. Please be prepared to pay the above fees at each visit.
No Show/Cancellation Policy:
Premier Medical is committed to providing our patients with exceptional care therefore your appointment time is valuable and has been reserved specifically for you. We kindly ask that you give a 24 hour notice if you need to cancel or re-schedule your appointment. If you no-show or do not cancel within 24 hours, you will be charged a fee.
Private pay accounts shall exist if a patient has no insurance coverage. For new patients, a payment of $150 is expected on the day of your appointment before treatment from your physician and balance is due upon completion of visit. Established patients will be required to make, and keep current, all payment arrangements specified in their individual payment plan.
If your Insurance Plan (Primary or Secondary) requires a referral from your Primary Care Physician it is YOUR responsibility to obtain it prior to your appointment and to have it with you at the time of the appointment. If you do not have your referral, you may be required to reschedule.
If you are seeing a physician as a result of a work related injury, please have your employer contact our appointment desk to schedule your appointment and provide necessary information.
We will submit to Medicare for the Medicare allowed amount. The patient will be responsible for the deductible and the co-insurance, which can be billed to a secondary insurance if applicable.
Returned Check Fees:
Any returned check from the bank for non-payment (insufficient funds) shall result in the patient’s account being assessed a $30 fee per check returned.
Delinquent accounts may be assigned to a collection agency. All collection costs will be added to your outstanding balance.
Forms Completion/Medical Records Requests:
From time to time various forms including but not limited to disability and FMLA forms will need to be filled out. There is a nominal fee for copying medical records in accordance with the state allowance.
We accept cash, MasterCard, Visa, Discover, American Express, debit cards, and checks.
Notice of Nondiscrimination and Accessibility
Premier Medical complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Premier Medical does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Premier Medical provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreters;
- Written information in other formats (large print, audio, accessible electronic formats, other formats);
- Provides free language services to people whose primary language is not English, such as:
- Qualified interpreters;
- Information written in other languages
If you need these service, ask for the office manager. If you believe that Premier Medical has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: James Hartman, 2880 Dauphin Street, Mobile AL 36606 / phone: 251-473-1900 / Fax: 251-341-3404. You can file a grievance in person or by mail or fax. If you need help filing a grievance, James Hartman is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
Premier Medical has arranged for language assistance services free of charge. Inquire at the Front Desk.
If you speak English, language assistance services, free of charge, are available to you.
Si usted habla español, tiene a su disposición servicios de asistencia con el idioma sin costo alguno.
모국어가 한국어일 경우 무료 언어지원 서비스가 제공됩니다.
Chúng tôi cung cấp dịch vụ hỗ trợ ngôn ngữ miễn phí cho quý vị, nếu quý vị nói tiếng Việt.
إذا كنت تتحدث العربية، فستتوفر لك خدمات المساعدة اللغوية مجانًا.
Wenn Sie deutsch sprechen, stehen Ihnen kostenlos Sprachhilfen zur Verfügung.
Si votre langue est le français, des services d’assistance linguistiques sont mis gratuitement à votre disposition.
તમે ગુજરાતી બોલતા હો, તો વિના મૂલ્યે, ભાષા સહાય સેવાઓ તમને ઉપલબ્ધ છે.
Kung nagsasalita ka ng Tagalog, may magagamit kang mga serbisyo sa lengguahe na walang bayad.
अगर आप हिन्दी बोलते हैं तो भाषा सहायता सेवा निःशुल्क उपलब्ध है।
ຖ້າທ່ານເວົ້າ ພາສາລາວ ແມ່ນມີບໍລິການຊ່ວຍເຫຼືອພາສາຟຣີໃຫ້ແກ່ທ່ານ.
Если ваш язык — русский, то вам могут быть предоставлены бесплатные услуги переводчика.
Se você fala português, está disponível atendimento gratuito com assistência ao idioma.
Türkçe biliyorsanız, dil yardım hizmetlerini ücretsiz olarak kullanabilirsiniz.