Welcome to Arrhythmia Consultants of Connecticut
Arrhythmia Consultants of Connecticut, LLC, (“ACC”) understands that each of our patients has unique needs for his or her medical condition and treatment. We work hard to meet your individual needs and to provide you with the best care possible. To best serve you and all of our patients, we have established policies that help ensure the smooth operation of our office. We ask that you review the policies described below, print and return this form with the signed acknowledgment that you have read and agreed to these policies.
Fees For Forms, Reports and Medical Records
Your insurance provider may pay for some or all of your healthcare bills. However, there are some services for which the insurance company does not pay. ACC, in keeping with the policies of many other medical practices, must charge a separate fee to cover the clinical and administrative costs of producing written reports and letters, completing forms, and providing copies of medical records. These are additional charges for activities for which insurance carriers do not reimburse providers for their time and administrative expense.
These supplementary services include: requests for letters or written narratives and summaries of your past or anticipated future medical condition and treatment; completion of employment physical or disability paperwork; Family Medical Leave Act (FMLA) forms; letters to utility companies or the Department of Motor Vehicles; and other similar services.
All fees must be paid prior to the release of reports, forms, letters, and medical records
No Show and Cancellation Policy
We would like you to understand that scheduled appointments are a time that is reserved for you and your provider. You have a responsibility to be on time for that scheduled appointment. If you do not intend to keep your scheduled appointment, please let us know as soon as possible, so that another patient may be scheduled.
If there are two consecutive “no show” appointments, or if there is a consistent pattern of “no show” appointments, we reserve the right to terminate your care with ACC. We also reserve the right to charge a $50.00 “no show / cancellation” fee if you miss or cancel an appointment without adequate prior notice. A minimum of 24 hours prior notice is required for appointment cancellations. Insurance companies do not pay for missed appointment time, and you will be responsible for the entire amount of the “no show / cancellation” fee.
Your scheduled office visits - and for those of our patients with implanted devices such as pacemaker and implantable defibrillators, telephone-based device monitoring - are a necessary component of our professional relationship. Repeated failure to keep scheduled office or telephone follow up appointments jeopardizes our ability to provide you with medical care, and may therefore result in dismissal from our practice.
You are required to settle this fee in full before your next appointment may be scheduled.
Renewal of Prescription Medications
It is important that you take all prescription medications that have been prescribed for you by ACC, and by your other physicians. Because your prescriptions have been prescribed specifically for you based on your medical conditions, prescription renewals require familiarity with your medical conditions and review of your medical records prior to our authorizing medication renewals. We have established the following guidelines for prescription renewals:
Prescription renewal requests must be made by your pharmacy to our office either by fax or e-prescribe.
- Prescription renewals will be processed only during normal office operating hours. Prescription renewals will not be authorized by the on-call physician after hours or on weekends.
- It is your responsibility to request prescription renewals far enough in advance of running out of your medication so that there is time for our office to process your renewal and for your pharmacy or mail order prescription service to process your renewal and, if necessary, mail your medication to you. Be sure to allow sufficient time for your prescriptions to be delivered to you.
- Our physicians will only review and authorize prescription renewals on days when they are working in our office. Therefore, it may take several days before your prescription renewal request can be processed. Again, please ensure that you notify your pharmacy far enough in advance so that you do not run out of medication.
- Our physicians can only authorize renewals for medications that have been prescribed by us. Requests for renewals for medications prescribed by other physicians should be directed to the appropriate prescriber. Under certain circumstances, such as when you are being discharged after a hospital admission, prescriptions for medications for conditions not treated by ACC may have been written by our physicians. In this case, we will again refer you to the primary prescribing physician when you need refills of these prescriptions.
- Prescription renewals cannot be provided for patients that have not been seen by one of our physicians for a period of more than one year. Please schedule your following visits with us accordingly to avoid running out of medications.
We provide an on-call physician 24 hours/day, 7 days/week, who directly receives notification of any messages left on our emergency call line. When the office is closed, the on-call physician is available to address urgent or emergency situations arising from the medical conditions for which you are under treatment by ACC. We ask that you follow these guidelines in placing a call to the on-call physicians:
- The on call physician cannot address medical conditions for which you are under treatment by other physicians and which fall outside of our area of medical practice. Calls related to such conditions must be directed to that physician’s office or covering physician. We do not provide on-call coverage to other medical practices.
- The on-call physician is available to address urgent or emergent situations only. Please address all other calls and requests for routine concerns to our office during normal business operating hours.
- The on-call physician will endeavor to return your call as quickly as possible. On occasion, there may be delays; for instance, if the on-call physician is involved with another patient or performing a procedure. We ask that you keep the telephone line which you have provided for us to return your call open and that you remain available so that we can return your call.
- The on-call physician may return your call from a telephone that does not allow Caller-ID identification. If you have Caller-ID blocking on your telephone line, please disable it while awaiting a return call. The on-call physician may not return phone calls to telephone numbers that do not accept Caller-ID blocked incoming calls.