Office Policy for Nanticoke Gastroenterology, P.A.
All office appointments are by Appointment only; there are NO walk-ins.
Appointment reminders - You will receive an automated appointment reminder call two business days prior to your appointment.
Nanticoke Gastroenterology, P.A. - Will charge a $50.00 NO SHOW FEE for any patient that does not give 24 hours notice of a cancellation or reschedule.
Seaford Endoscopy Center, LLC -Will charge a $100.00 NO SHOW FEE for any patient that does not give 24 hours notice of a cancellation or reschedule.
Returned Checks - There is a $35.00 charge for all returned checks, payable in cash and credit card only.
Self-Pay Patients - All self-pay patients are responsible for a $150.00 deposit for the initial office visit. Self-pay patients will be responsible for a $500 deposit on all procedures which is due prior to the procedure. All charges will be based on the Medicare Fee Schedule. A payment plan can be set up for the remainder of the balance.
Forms - Please allow five (5) days from the time you drop off the form for completion.
Medication Refills - Dr. Mackler requires all patients to be seen once (1) a year to maintain prescriptions. If you do not need to see the doctor please allow 72 hours to refill your prescription.
Test Results - All tests will be discussed with you at your follow up visit. Office staff are not authorized to give test results over the phone, so please don't ask.
Identification and Insurance Cards - The patient is responsible for bringing identification and insurance cards to all appointments.
Billing - I authorized Nanticoke Gastroenterology, P.A. to bill my insurance company. I hereby authorize direct payment to Nanticoke Gastroenterology, P.A. for any insurance benefit otherwise payable to me for any services rendered by Nanticoke Gastroenterology.
HIPPA - I have reviewed the Notice of Privacy Practices for Nanticoke Gastroenterology, P.A.
Collections: I understand that I am responsible for all collections, interest, and legal fees associated with the collection process.
Violation of these policies can result in dismissal from the practice.
I have read and agree to all the above conditions.
Date of Birth:_______________________________
Signature of Patient:_______________________ Date:______________