Missed Appointment Policy and Procedure

RIVERSIDE FAMILY CLINIC, INC

IMPORTANT NOTICE FOR ALL PATIENTS

Kindly give 24 hours advance notice if you are unable to keep your scheduled appointment time.

Missed Appointment Policy

It is the policy of this clinic to require 24 hours advance notice for all appointment cancellations to allow the Nurse Practitioner maximum availability to her patients.  To ensure availability is managed appropriately, it is necessary for us to have a following policy for missed appointments:

First Missed Appointment

A notification will be sent to the patient of missed appointment and our clinic policy regarding missed appointments.

Second Missed Appointment

A notification will be sent to the patient of missed appointment, along with a copy of our clinic policy, and a bill for missed appointment charge of $25.00 or $50.00*.  This charge is not covered by insurance and is the patient’s responsibility.  The missed appointment fee must be paid prior to future office visits.  New patients who miss a second scheduled appointment will not be permitted to schedule future appointments or be accepted into the practice.

Third Missed Appointment

A notification will be sent to the patient of missed appointment, our clinic policy, and a bill for a missed appointment charge of $25.00 or $50.00*.  This charge is not covered by insurance and is the patient’s responsibility.  The patient may also be dismissed from the practice due to excessive missed appointments.

*Missed appointment fees for standard office visits will be charged $25.00.  Missed appointment fees for Complete Physicials, Well Woman Exams, Well Child Exams or Procedures will be charged at $50.00 as considerable time is set aside for these visits.  Again, this charge is not covered by insurance and will be the patient’s responsibility.

Appeal Policy

You have the right to appeal the missed appointment fee by contacting our office manager, Summer Noland at 812-291-5993.  Appeal request will be reviewed by patient’s Provider and office manager.  Appeal decision will be sent in writing to the patient.

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