- 2 All contents copyright (c) OrlandoPlasticSurgeryAssociates.com
- 3 USE OF INFORMATION AND RESOURCES
- 4 OFFICE POLICY
- 5 ARRIVAL (first-time patients)
- 6 RESCHEDULING
- 7 CANCELLATION POLICY
- 8 REFUND POLICY
- 9 LATE ARRIVAL POLICY
- 10 FINANCIAL POLICY
- 11 COSMETIC PROCEDURES/SELF PAY
- 12 INSURANCE
- 13 MEDICARE
- 14 CO-PAYMENTS AND DEDUCTIBLES
- 15 SELF-PAY
- 16 NON-COVERED SERVICES
- 17 REFERRALS/AUTHORIZATIONS
- 18 CLAIM SUBMISSION
- 19 PATIENT BILLING
- 20 FORM COMPLETION
- 21 PAYMENT POLICY
- 22 LINKS
- 23 DISCLAIMER OF WARRANTY
- 24 LIMITATION OF LIABILITY
- 25 INDEMNIFICATION
- 26 MISCELLANEOUS
- 27 COPYRIGHT
- 28 PERSONALLY IDENTIFIABLE INFORMATION
- 29 AUTHORIZATION FOR RELEASE OF MEDICAL RECORDS
By entering this site or the links accessible through this site, you expressly agree to be bound by this agreement. The information and the resources contained on and accessible through this site are made available by OrlandoPlasticSurgeryAssociates.com and are subject to your agreement to their terms and conditions.
All contents copyright (c) OrlandoPlasticSurgeryAssociates.com
All rights reserved, OrlandoPlasticSurgeryAssociates.com makes this Web site available and free to all users for the sole purpose of providing educational information on health-related issues. The information and resources contained in this web site are not meant to substitute or contradict professional medical advice. This web site is not intended for medical care of any kind.
All materials on this Internet site, including the site’s design, layout, and organization, are owned and copyrighted by OrlandoPlasticSurgeryAssociates.com and are protected by U.S. copyrights.
Only your personal use of such materials is permitted, which means that you may access, download, or print such materials for your personal use only. Commercial use of any sort is expressly prohibited. You agree not to change or delete any copyright or proprietary notice from materials downloaded from this site or any site accessible through this site. Any requests for OrlandoPlasticSurgeryAssociates.com’s permission to publish, copy, reproduce, distribute, transfer, or otherwise use any materials contained in the Web site should be e-mailed to email@example.com.
USE OF INFORMATION AND RESOURCES
OrlandoPlasticSurgeryAssociates.com makes this site available for the sole purpose of providing general information on health-related topics.
This site is available for informative purposed only. This site may not be used as a supplement or alternative for health care, the information provided is merely for educational purposes, and its accuracy is not guaranteed. Do not use this site as a substitute for medical care. Please consult with your physician or other medical care provider regarding any medical questions you may have. This site is not sponsored or maintained by physicians or licensed medical care providers and may not be used for medical diagnosis or treatment. Do not use this site to disregard any medical advice, nor to delay seeking medical advice, because of something you read or see in this site.
You understand and agree that neither OrlandoPlasticSurgeryAssociates.com or linked domain names are responsible or liable for any claim, loss, or damage, of any kind, directly or indirectly resulting from your use of this site or the information or the resources contained on or accessible through it.
OrlandoPlasticSurgeryAssociates.com expressly disclaims any implied warranty or representation about the information or accuracy, relevance, timeliness, completeness, or appropriateness for any particular purpose of any kind.
In our commitment to provide a unique and outstanding experience to each and every one of our patients, and out of consideration for Dr. Johnston’s time and schedule, we have adopted the following policies:
ARRIVAL (first-time patients)
Please arrive for your appointment(s) 10 minutes prior to the scheduled starting time. This allows you the time to fill out the appropriate patient intake form, use the restroom, become acclimated to our office, etc. If late arrival is unavoidable, your service(s) may be shortened in order to preserve and respect our next patient’s scheduled appointment time. If you are using a gift certificate, half-off website voucher, coupon, discount, etc, you MUST mention this when booking your appointment. Failure to do so will void the full value of said coupon, voucher, gift certificate, etc.
If it is necessary for you to reschedule your session(s), 24 -48 hours notice is required for individual patients. Please refer to the follow section regarding late cancellations. We reserve the right to reschedule treatments under the same guidelines.
A credit card will be required to reserve your cosmetic consultation with Dr. Johnston. In the event of a no-show or failure to cancel your reservation within 24-hours prior to your start-time, your card will be charged $50 for your missed appointment.
We do not ordinarily offer refunds of any kind, including gift certificates, pre-paid treatments, packages, etc. If you do not want to use prepaid services for yourself, please feel free to share them with others. They’ll deeply appreciate the offer and service. We are compassionate people, and do understand that hardships occur. If you have purchased a package and do indeed feel that a refund is a necessity that impacts the welfare of yourself and/or your family, we are willing to address such issues on a case-by-case basis, and ONLY in the event of hardship. Scheduling, personality, and customer service issues do not warrant this exception. Partially used packages will be prorated and adjusted to reflect regular pricing on services already used, and complimentary sessions are voided as the package was refunded.
LATE ARRIVAL POLICY
As a courtesy to our other guests and staff, appointments will be automatically cancelled 15 minutes after scheduled start time and charged according to our cancellation policy. We regret that late arrivals will not receive extension of scheduled appointments. In special cases, and when our schedule will allow, we may be able to accommodate a partial or full appointment. This will be solely at our discretion and only with proper, 60 minute advanced notification of your late arrival.
A note regarding the surge of ‘half-off’ websites, ie: Groupon, Living Social, etc. With all of the Groupon copycat ½ off sites in the marketplace today; one can virtually receive a ½-price service at a different establishment every day of the week. Our approach to the discounted deals we offer is basically that they attract new clients to our wellness center at an amazingly affordable price…for their first visit. Please know that we are not in a position to honor these offers more than once per person. You can certainly purchase as many as you like as gifts for others…share the love.
Thank you for choosing Dean L. Johnston, M.D., Inc. as your health care provider. We are committed to the success of your treatment. All matters concerning your medical care will be considered to be a health care treatment and subject to the Medical Practices Act of Florida. The medical services provided by our office are services you have elected to receive, which imply a financial responsibility on your part.
COSMETIC PROCEDURES/SELF PAY
Elective procedures must have financial arrangements made in advance of scheduling. Payment for services is due two weeks prior to the procedure. The practice will accept cash, carrier’s checks, personal checks, and the following major credit cards: VISA, MasterCard, and American Express. We charge a $25 service fee for all returned checks. As a convenience to you, financing is also available. For those individuals who pay by credit card, debit card, or finance companies, you are not eligible for credit card challenge or “charge back” to the finance companies once the service is provided as per this agreement.
We participate in most insurance plans. If you are not insured by a plan we participate with, payment in full is expected at each visit. If you are insured by a plan we participate with but do not have an up-to-date card, payment in full for each visit is required until we can verify coverage. Knowing your insurance benefits is your responsibility. Please contact your insurance company with any questions you may have regarding your coverage plan.
We are a participating Medicare provider. Medicare as well as your secondary insurance (if any) will be billed for you. However, that does not mean that all services are covered. Patients are responsible for paying their annual deductible if it has not been met. You are also responsible for any co-payments, which are usually 20% of the allowed amount for an item or service.
CO-PAYMENTS AND DEDUCTIBLES
All co-payments and deductibles must be paid in full at the time of service. This arrangement is part of your contract with your insurance company.
Payment in full is due at the time of service if you do not have health insurance.
Please be aware that some services you receive may not be covered, or considered reasonable or medically necessary for coverage by Medicare or other insurance carriers. You are responsible for payment of these services.
We are required to follow the guidelines of your managed care plan, which may require a referral from your primary care physician prior to your appointment when visiting a specialist’s office. Therefore, if a referral is required and not presented at the time of your visit, your appointment will be rescheduled or you will be financially responsible for services received, paid in full upon completion of the visit.
As a courtesy service to you, we will submit your insurance claims for the services rendered in our office, and assist you in anyway we reasonably can to help get your claims paid. Your insurance company may need information from you. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility, whether or not your insurance company pays your claim.
You will receive a statement from us on the status of your claim and encourage your help in receiving payment after 30 days. You will be sent up to three statements for your financial responsibility after your insurance has processed Claims. After the third notice your account may be forwarded to a Collection Agency. If your account is assigned to an outside collection agency, additional fees will be added. Please let the billing departments know if you have difficulties resolving your bill. Payment arrangements may be considered on a case-to-case basis.
Completing Disability Forms, Family Leave Forms, or your third insurance forms require office staff time, copies to be made, and time out of Dr. Johnston’s schedule which takes away from patient care. Therefore, our charge for this service is $15.00 and we request up to three business days for completion of this task.
By visiting DEANJOHNSTONMD.COM you agree that all balances will be due in full at the time of your office visit. We will provide you with a copy of your bill and the insurance credits upon request. We reserve the right to charge a $50.00 fee for missed appointments and an additional charge for surgical appointments. If you are unable to make your appointment, please cancel or reschedule by calling our office at least 24 hours in advance.
If you are paying by insurance, you the undersigned certify that you (or your dependent) have coverage with your insurance as presented and assign directly to Dean L. Johnston, M.D., Inc. all insurance benefits payable to you for services rendered. You understand that you am responsible for co-pays, deductibles, and/or non-covered services. You hereby authorize the doctor to release all information necessary to secure payment of benefits. You authorize Release of Medical Information to your insurance carrier, or requested physician to provide continuity of care. You authorize any physician or medical facility that has treated me in the past to release a copy of your record to Dean L. Johnston, M.D., Inc. you authorize use of this signature on all insurance benefits.
You understand that it is your responsibility to inform the Doctor’s office if there is a change in your health insurance information and/or contact information. By using this website WWW.DEANJOHNSTONMD.COM you understand and accept these terms.
If you have any questions regarding our office & financial policy please contact us at: firstname.lastname@example.org.
This site also includes links to other Internet sites. Be aware that OrlandoPlasticSurgeryAssociates.com does not control, makes no guarantees about, and disclaims any express or implied representations or warranties about the accuracy, relevance, timeliness, completeness, or appropriateness for a particular purpose of the information or the resources contained on these or any other Internet sites.
Further, the inclusion of these links is merely for your convenience and is not intended and does not reflect OrlandoPlasticSurgeryAssociates.com’s opinion on the accuracy or the importance of these other sites. All information in any OrlandoPlasticSurgeryAssociates.com site, or associated or linked site, is extracted, read, used, or relied upon by you at your own risk.
DISCLAIMER OF WARRANTY
OrlandoPlasticSurgeryAssociates.com and its suppliers and vendors disclaim all express or implied representations with regard to the information, services, products, materials, and any other resources contained on or accessible through this site. All information provided by OrlandoPlasticSurgeryAssociates.com is made available “as is” and “as available” without warranty of any kind, or any express or implied promise.
LIMITATION OF LIABILITY
To the maximum extent permitted by applicable law, in no event shall OrlandoPlasticSurgeryAssociates.com be liable for any direct, indirect, special, punitive, incidental, exemplary, contractual, or consequential damages, or any damages whatsoever of any kind, resulting from any loss, which by way of example, includes loss of use, loss of data, loss of profits, business interruption, litigation, or any other pecuniary loss, whether based on breach of contract, tort (including negligence), product liability, or otherwise, arising out of or in any way connected with the use or performance of this site, with the delay or inability to use this site, or with the provision of or failure to make available any information, services, products, materials, or other resources contained on or accessible through this site, even if advised of the possibility of such damages.
With respect to products, goods, or services purchased from any entity identified, listed, named or contacted through OrlandoPlasticSurgeryAssociates.com’s Web site, or any links to OrlandoPlasticSurgeryAssociates.com’s Web site, in no event shall OrlandoPlasticSurgeryAssociates.com be liable for any direct, indirect, special, punitive, incidental, exemplary, or consequential damages, or any damages whatsoever, resulting from any loss of use, loss of profits, litigation, or any other pecuniary loss, whether based on breach of contract, tort (including negligence), product liability, or otherwise, arising out of or in any way connected with the provision of or failure to make available any such products, goods, or services, even if advised of the possibility of such damages.
You acknowledge and agree that the limitations set forth above are elements of this agreement, and that this site would not be provided to you absent such limitations.
You agree to indemnify, defend, and hold harmless OrlandoPlasticSurgeryAssociates.com from any liability, loss, claim, and expense (including reasonable attorneys’ fees) related to your violation of this agreement or use of this site in any manner. Your use of this site shall constitute your acceptance of the terms of this Agreement, as revised and modified, if any, each and every time you access this site. OrlandoPlasticSurgeryAssociates.com may modify this agreement at any time, and such modifications shall be effective immediately upon posting of the modified agreement.
OrlandoPlasticSurgeryAssociates.com’s failure to insist upon strict enforcement of any provision(s) of this agreement shall not be construed as a waiver of any provision or right.
This agreement and the resolution of any dispute related to this agreement or this site shall be governed by and construed in accordance with the laws of Florida, without giving effect to any principles or conflicts of law. Any legal action or proceeding between OrlandoPlasticSurgeryAssociates.com or its links, suppliers or vendors and you related to this agreement or this site shall be brought exclusively in a state or federal court of competent jurisdiction sitting in the County of Orange, Florida.
All materials on this Internet site, including the site’s design, layout, and organization, are owned and copyrighted by OrlandoPlasticSurgeryAssociates.com are protected by U.S. copyrights.
PERSONALLY IDENTIFIABLE INFORMATION
Our policy is to allow our users to anonymously access the information on OrlandoPlasticSurgeryAssociates.com properties. OrlandoPlasticSurgeryAssociates.com does not collect, sell, or provide any personally identifiable information regarding you or other users, unless you voluntarily provide that information to us for that purpose. OrlandoPlasticSurgeryAssociates.com does not place cookies in your browser.
AUTHORIZATION FOR RELEASE OF MEDICAL RECORDS
By using our online form your authorization to release medical records includes Federal and/or State protected information under Florida Statutes 394.459(9) psychiatric information, 397.053/396.112 drug and/or alcohol abuse information, 381.609 HIV and AIDS related conditions, and/or 397.501(3) records of a minor client.
You agree that you understand this authorization will expire 90 days from the date of form submission or when accepted upon, whichever event occurs first. You hereby release to Orlando Plastic Surgery Associates, its employees, and appointed representatives from any and all liability that may arise from the release of information as you have directed.