Tennessee Family Medicine
1047 Glenbrook Way
Hendersonville, TN 37075
We try to answer calls as soon as possible but in order to minimize interruptions during office visits we may not be able to return your call until the end of the clinic day. If you have an emergency, defined as an injury or illness which may represent a danger to life or limb, please call 911 or go to the nearest Emergency Department. We also have the Patient Portal service where you can send notes or questions directly to your chart. Your response will come by a secure website, and you will receive a notification only by your email when your Portal has been updated. These too can take a day to return. If you have an urgent medical need, it is still best to call early in the morning for an appointment the same day. We do keep several slots open daily for urgent needs. We can only answer medical questions for established patients.
Initial prescriptions and medication refill requests are designed to be completed during your scheduled appointments. We try to maintain refills enough to last until your follow up appointment is due. When you are out of additional refills, that would be the ideal time to schedule your next appointment. Some medications will have refills to last a year, but medications that require physical or laboratory monitoring may last only 3 to 6 months. Other prescriptions require additional time and administrative work to fill, and these may require an office visit as well. Some clinics are charging additional fees to complete refills that are not associated with an office visit and we are trying hard to avoid this. Refill requests that are made outside of a regularly scheduled appointment may take up to 3 days to process, so please plan accordingly.
We do not refill prescriptions on nights or weekends as a general rule. Also, Class II controlled prescriptions cannot be called in to pharmacies and must be seen in person to refill. There are some new DEA rules that allow 3 months of prescriptions to be written at one office visit with post-dated refill dates. If you are on medications for Attention Deficit Disorder please ask about this new policy at your next visit.
Please be sure if you leave a message for refills to include your name, date of birth, preferred pharmacy, name of the medication, dose and how often you take it to confirm the process.
Referral Requests and Pre-Authorization Forms
Many insurance companies have additional administrative processes that are required to see a specialist. It is the responsibility of the patient to obtain a referral prior to appointments with a specialist. These referral requests are to be completed during your scheduled appointments. We are held responsible to send you to the proper specialist for your specific problem. In appropriate cases we may be able to complete referral requests without an office visit. Some clinics are charging $25 for this service because of the administrative costs involved. We are trying hard to avoid this. Our clinic appointments will take priority, so please be aware that it can take up to 3 days to process referral requests that are made without an office visit.
Laboratory services are available at the clinic for Urinalysis, Pregnancy, Strep, Influenza and Guaiac testing. Other testing must be done at a certified laboratory. We use Americal Esoteric Laboratory ( AEL) for or laboratory of choice. The laboratory phlebotomist will draw labs in the clinic for your convenience, prepare the specimens for testing, and they are picked up during the day by a distribution service representative.
You may receive a bill from either AEL, Tennessee Family Medicine or both depending on the lab requested. Billing through Tennessee Family Medicine is arranged for discounted prices for your convenience on selected tests. If you feel you have received a bill inappropriately from the lab, we are happy to assist in any way possible. The most common issues pertain to Complete Physical Exams (CPE) billing. Please be certain your insurance covers wellness or CPE visits before your appointment. There is not much we can do about billing charges for non-covered visits.
If your insurance requires that your labs be performed at a specific lab other than AEL, such as Quest or Labcorp, we may not be able to draw the blood at our clinic but we are happy to send an order to the Hospital lab which can draw and process this for you.
Laboratory results are reviewed as quickly as possible and either called to you or a letter will be sent if normal. These are reported on a priority basis with the most urgent results called first. Results are also available on our Patient Portal service. If you find results online before you have been contacted please be patient as we process and attempt to contact you. If you have not heard any results within a week, please call and let us know.
Payment of Fees
Payment of fees not covered by your insurance plan are due on the day of your scheduled appointment. These fees include copayment, deductibles and outstanding balances. You may pay by cash, check, money order, Visa or Master Card. Any checks that are returned will be charged an additional $25 fee.
We will file your insurance claim as a service to you. In order to do this we ask that each patient or responsible family member complete an insurance form with the assignment of benefits assigned to us on the initial visit and annually thereafter or if your policy changes. All of this paperwork is time consuming for both of us so please allow additional time to fill out before your first visit. We will do all that we can to process insurance claims, but please remember that your coverage is a contract between you and your insurance company. Any balance that your insurance company does not pay or is considered a non-covered service is due from you or your responsible party.
Many insurance companies require a deductible to be satisfied each year by the patient or responsible party before insurance benefits begin. If the deductible has not been satisfied or there is a question whether the service we provide is a covered service, it is the responsibility of the patient or responsible party to provide payment at the time of service. We will verify insurance coverage before your visit. During the verification process we may find that your deductible has not been met and will have to collect a reasonable amount before the office visit. Please keep in mind that insurance coverage is a contract between you and your insurance company. If a claim processed is a covered service the payment will be applied to any balance on the account and difference refunded or credited to the account as requested by the patient or responsible party.
Additional Services Not Covered by Insurance
The completion of forms (school physicals, administrative physicals) should be done at the time of your office visit. These physicals may not be a covered service by your insurance company. There may be an additional charge for complex forms (disability forms, handicap placards, FMLA and other paperwork) to be filled out at the time of an office visit.
Insurance coverage limits will never have an effect on the quality of care provided at Tennessee Family Medicine. The same quality care is provided regardless of payor whether cash pay, commercial insurance or medicare. Not all services, labs, examinations, procedures are covered by insurance companies and even within one insurance carrier the benefits will vary widely. Please keep in mind that just because a service may not be covered by insurance does not mean it is not beneficial such as Complete Physical Exams or Tetanus booster shots for preventive health services. In much the same way, Car Insurance does not cover oil changes, gas, tires or regular maintenance. Covered or not, some services are recommended for your safety and well being. It is your choice to decide.
Preventive Visits and Problem Related Visits
For years there has been confusion about Complete Physicals. Coverage of Physicals varies widely from each insurance carrier. Please check with your insurance company prior to scheduling a Yearly Complete Physical. There are many different plans, and each plan may have different policies. It is administratively impractical for us to verify this information correctly for you.
Regardless, Complete Physicals are highly recommended. This is our only chance to cover preventive issues that are not part of routine problem generated visits. At your Physical we start with a review your medical history, family medical problems that place you at additional risks, social habits that may cause risk, and age associated risks. Then a thorough physical examination is performed to catch any such problem at an early stage before it becomes a problem. This is when you will have your breast exam, cervical exam and pap or for men a prostate exam, and screening for colon cancer, skin exam, etc. EKG and laboratory tests are performed to monitor for additional risks that can effect your health. Age or risk appropriate testing will be scheduled such as colonoscopy, mammogram, bone density or stress testing. Immunization discussion, and preventive counseling such as diet and exercise are covered.
These visits are time consuming and are designed purely for preventive health issues, not problem focused. Most insurance companies will not pay for Complete Physical Examinations and problem specific complaints on the same day. It is a very frustrating part of dealing with insurance companies, and not necessarily our policy, but we have to abide by their rules.
We try to adhere to our appointment schedule as best as we can. Unfortunately, there are many times when this is impossible because people are very unpredictable as a rule. If you have a very tight schedule, we recommend making the first appointment of the morning at 7:30 a.m. (8:00 a.m. Summer Hours) or immediately after lunch at 1:30 p.m. All of the administrative tasks mentioned above are some of the reasons that we may run behind schedule and in fairness to all our patients we are instituting these policies.
There may be times when you could be asked to reschedule an appointment to discuss specific problems, especially if brought up during a physical or if you bring a list of complaints during a 15 minute appointment. Some problems take much longer to resolve properly and it would be inappropriate to rush through any issues you have, and unfair to those that are scheduled after you. It is never popular to ask someone to reschedule for additional complaints, but we are more interested in doing what is right for everyone. Please let the scheduler know all your concerns when you make your appointment so that we can do our best to allow the appropriate time.
We do require 24 hours notice of cancellation for appointments. We offer email reminders of scheduled appointments and calls to remind before upcoming appointments as a courtesy. If cancellation is less than 24 hours and we are unable to fill your appointment time you will be billed $50.00. This is not to generate revenue as some would argue, but to cover only part of the loss. Please keep in mind we are paying overhead on the time you book.
Statements and Collection Process
We send out monthly statements. We understand that many people wait for their insurance company to pay and in the meantime do not pay on their account. However, the statement we send you reflects payments from your insurance company and the balance due is your responsibility.
Please feel free to contact our office with any questions regarding your statement. We understand that insurance explanation of benefits (EOB’s) can be confusing. If you have any questions regarding your policy, please contact your insurance company regarding your specific coverage.
We are always happy to set up a payment plan if you are having trouble paying your bill in full.
We are in the business of caring, but we also have a business to run and appreciate your timely payments. Accounts not paid are subject to collection. Any account sent to collection will be dismissed from this practice. Once a patient is dismissed they will no longer be able to schedule appointments or receive refills. We strive to make multiple attempts to contact our patients about outstanding balances before we are forced to rely on collections, so at this point all dismissals are permanent.
TennCare | Medicaid Information
Tennessee Family Medicine does not accept or have a contract with TennCare or any Medicaid insurance programs.
If a patient qualifies for Tenessee Medicaid ( TennCare, UHC Community Plan, Amerigroup, etc.) they are required by their Medicaid plan to see in-network providers. This is a rule cited in the Member Handbook they receive when they are accepted by Medicaid.
If any current patients change from a comercial insurance or self pay to a Medicaid Product, we would not be able to continue to see them unfortunately. They will need to change to a Medicaid Provider.
This is a rule from Tenncare/Medicaid that the patients are required to follow in order to continue to qualify for Medicaid. The way Tenncare/Medicare views this is if they can afford to pay self pay for medical care then they do not qualify for Medicaid and this could possibly cause them to loose their Medicaid coverage. This is a government rule, not our rule.
We researched this thoroughly and the supervisor at Tennessee Medicaid made it clear that providers (contracted with Medicaid or not) were NOT to accept self pay payments from people who qualify for Medicaid.
When the patient signs up with Medicaid, they are saying they will see in-network providers because they cannot afford private insurance or to be self pay. If they then pay self pay, it could be considered Medicaid fraud. So if we accept self pay payment from patients we know have any form of Medicaid, we are considered by the state to be aiding in the commitment of Medicaid fraud.
Patients with Traditional Medicare (Not Medicare Advantage Plan) cannot pay for visits as self pay patients. Our office is legally required to file Medicare Benefits for anything Medicare covers. Since we have a contract with Medicare, if we accept a self pay rate and do not file their insurance we would be in breach of contract and could lose our contract with Medicare and be subject to severe penalties. This does not apply to cosmetic or non-covered procedures offered by the clinic. Non-covered procedures are designated as cash-pay only.
Our panel is currently closed for Traditional Medicare patients. We cannot accept new Traditional Medicare patients as self pay.
We also cannot currently accept new Traditional Medicare patients that are not already established with the clinic.
Medicare Advantage Plans
Medicare Advantage plans are a separate entity from Traditional Medicare. We have reviewed all of the locally available Medicare Advantage plans thoroughly and have come to the conclusion there is only one that provides true quality and benefit for its members and provides a quality network of physicians / providers to care for the members. That plan is Healthspring, or now Cigna-Healtspring. This is not a final decision by any means and we do review the plans yearly as changes are made. If any other plan competes with or surpasses the Cigna-Healthspring plan we will certainly credential with that plan when the time is right. We have found that Healthspring does provide its members with superior coverage and health options that traditional medicare does not.
Health Insurance Portability and Accountability Act - Privacy of your information.
Over 138+ pages and more complicated yearly. We strive to be fully compliant with the latest guidelines. If you spot any concerns please don’t hesitate to let us know.
Your information. Your rights. Our responsibility. This notice describes how medical information about you may be used and disclosed and how you can get access to this information.