Patient Information

Office Visits

We request that all new patients complete the patient registration forms with information regarding present urologic problem, medical history, current medication and insurance coverage.

At each visit you will be asked to update this registration information. This enables our staff to know and serve you at the highest level.

We ask that you bring any pertinent records, x-rays, and test results with you to the office visit, as well as your insurance card.

At Jersey Urology Group we attempt to see each patient on schedule and apologize when our appointments fall behind due to emergencies.

Cancellation/Late Arrival Policy

It is important for Jersey Urology Group, P.A. and our other patients that a patient arrives on time for a scheduled appointment. We suggest a patient arrives at least ten (10) minutes prior to a scheduled appointment time in order to complete the check-in process by the scheduled appointment time. Jersey Urology Group uses a state-of-the-art, automated kiosk check-in process at its offices, similar to an airline kiosk check-in. Patients who are not familiar with our kiosks may need additional time to familiarize themselves with the process.
Please note that Jersey Urology Group may charge a patient a one hundred dollar ($100.00) fee for missing a scheduled office appointment and a one hundred and fifty dollar ($150.00) fee for missing a scheduled procedure at a location other than our offices (for example, a surgery center) without giving at least twenty-four (24) hours prior notice. Jersey Urology Group may consider an appointment “missed”, and will not be able to see a patient that day, if a patient does not complete the check-in process by the scheduled appointment time. If a patient believes that he or she will not be able to be on time for a scheduled appointment, a patient should call Jersey Urology Group’s office at 609-927-8746 as soon as possible to reschedule or cancel the appointment

Prescriptions and Refills

Our providers pride themselves in providing prescriptions and refills during your appointment. Please check your medication and plan accordingly so we can best serve you at each visit.

During non-office hours the physicians will have limited access to your medical records and therefore are not able to routinely write a prescription or issue a refill.

Payment Obligations

Our facility, staff, equipment and supplies are designed to meet your health care needs but they are costly. Please help us contain costs and avoid finance charges by rendering payment promptly at the time of service. Co-pays, deductibles, fees for uncovered services, and charges to patients with insurance coverage with whom we do not participate are due at the time of the office visit. If you do not have your co-pay or have an unpaid balance due at the time of your visit, your visit must be rescheduled to another date/time when you are able to pay your co-pay or unpaid balance. All patient balances that remain unpaid after 180 days, with no response to our requests for payment, may be referred to a collection agency. Please be aware that if a balance remains unpaid, you and/or your family member may be discharged from Jersey Urology Group. If this does happen, you will notified by certified mail, return receipt requested, that you have 30 days to find alternative medical care.

Credit Card Policy

Jersey Urology Group now requires all patients to maintain a valid credit card on file except: 1) those patients who do not have a deductible or co-insurance responsibility with their insurance carrier(s); or 2) Medicare beneficiaries who also have secondary insurance coverage. Patients to whom this policy applies will be required to electronically sign a credit card authorization form at the time of check-in for their appointment. This credit card authorization form permits Jersey Urology Group to charge your credit card it the event you have any personal financial responsibility for the services we provide to you. If this policy applies to you and you do not place a credit card on file or fail to sign the credit card authorization form, we will not be able to see you for your scheduled appointment. We are happy to reschedule your appointment for another time once you fulfill these requirements.

This policy allows us to avoid the wastefulness of paper, stamps and envelopes. It also allows us to ensure patient responsible balances are paid in a timely manner. To be fair, this policy will be administered uniformly to all patients to whom it applies, even those who continue to pay their bills on time. Patients will be notified by their insurance companies through an Explanation of Benefits of their individual financial responsibility, if any. Jersey Urology Group will not charge your credit card unless your insurance carrier confirms that you are financially responsible for the services we provided. Jersey Urology Group stores your credit card information in a secure area not available for use outside of our billing department. As always, Jersey Urology Group will work with you on all payment issues. Thank you for your cooperation with this policy and ensuring that Jersey Urology Group is paid for services provided to you.

Insurance

We participate in many health insurance plans, including Medicare and HMOs.

We do not participate in Medicaid or any Managed Medicaid product.

Please inquire about your specific carrier.

For any questions or concerns regarding insurance, please contact our billing coordinator at 609.927.8746.

To obtain a copy of medical records

Fill out this form and return to our office to request medical records:

Release of Records Form

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