Common use of Laboratory Services Clause in Contracts

Laboratory Services. Your physician may order laboratory services to assist in diagnosing your condition or as preventative care to determine your current health status. Your insurance benefits may not cover all services provided or ordered by the provider. This includes: pap smears, testing for sexually transmitted disease, screening and diagnostic labs, genetic testing and drug screening. In some instances these services may be applied to your annual deductible or not covered. It is the patient’s responsibility to know the coverage, limitations and exclusions of your insurance policy. WHASN’s central billing office accepts checks as payment on an account. In the event a check is returned by the bank for “non- sufficient funds”, “closed account”, “return to maker”, “check voided”, “stop payment” and “un-authorized signature”, a $25.00 fee will be assessed to your account. We may choose to proceed with legal action which will result in additional fees to you or the guarantor of the account. You are responsible for the additional fees. If it is necessary to cancel your scheduled appointment, we request that you notify us at least 48 hours prior to the appointment. A “no-show” is someone who misses an appointment without cancelling it at least 48 hours prior to the scheduled appointment time. A failure to present at the time of a scheduled appointment will be recorded as a “no-show”. You will be charged $25 for “no-show” appointments. There is a $25.00 charge for each FMLA/disability form/signature completed by this office. Payment is due at the time the form is submitted. All FMLA/disability forms are completed by the office staff. There is generally a 7-14 day waiting period for the completion of these forms. The physician’s documentation in your medical chart serves as the basis of all FMLA/disability forms and cannot be enhanced by yourself or the office staff. It is important that you understand the difference between FMLA and disability forms. Disability forms can only be completed after the physician has determined the patient has a medical condition that warrants the patient to be off work. Normal symptoms during pregnancy (nausea, vomiting, headaches, swelling, pelvic pain/pressure) do not typically qualify as a medical disability.

Laboratory Services. Your physician provider may order laboratory services to assist in diagnosing your condition or as preventative care to determine your current health status. Your provider will choose an in-network lab to send any blood work, cultures, or other tests based on their preference. Your provider Your insurance benefits may not cover all services provided or ordered by the provider. This includes: pap smears, testing for sexually transmitted disease, screening and diagnostic labs, genetic testing and drug screening. In some instances these services may be applied to your annual deductible or not covered. It is the patient’s responsibility to know the coverage, limitations and exclusions of your insurance policy. WHASN’s central billing office accepts checks as payment on an account. In the event a check is returned by the bank for “non- non-sufficient funds”, “closed account”, “return to maker”, “check voided”, “stop payment” and “un-authorized signature”, a $25.00 fee will be assessed to your account. We may choose to proceed with legal action which will result in additional fees to you or the guarantor of the account. You are responsible for the additional fees. If it is necessary to cancel your scheduled appointment, we request that you notify us at least 48 hours prior to the appointment. A “no-show” is someone who misses an appointment without cancelling it at least 48 hours prior to the scheduled appointment time. A failure to present at the time of a scheduled appointment will be recorded as a “no-show”. You will be charged $25 for “no-show” appointments. There is a $25.00 charge for each FMLA/disability form/signature completed by this office. Payment is due at the time the form is submitted. All FMLA/disability forms are completed by the office staff. There is generally a 7-14 day waiting period for the completion of these forms. The physician’s documentation in your medical chart serves as the basis of all FMLA/disability forms and cannot be enhanced by yourself or the office staff. It is important that you understand the difference between FMLA and disability forms. Disability forms can only be completed after the physician has determined the patient has a medical condition that warrants the patient to be off work. Normal symptoms during pregnancy (nausea, vomiting, headaches, swelling, pelvic pain/pressure) do not typically qualify as a medical disability.

Laboratory Services. Your physician may order laboratory services to assist in diagnosing your condition or as preventative care to determine your current health status. Your insurance benefits may not cover all services provided or ordered by the provider. This includes: pap smears, testing for sexually transmitted disease, screening and diagnostic labs, genetic testing and drug screening. In some instances these services may be applied to your annual deductible or not covered. It is the patient’s responsibility to know the coverage, limitations and exclusions of your insurance policy. WHASN’s Our central billing office accepts checks as payment on an account. In the event a check is returned by the bank for “non- sufficient funds”, “closed account”, “return to maker”, “check voided”, “stop payment” and “un-authorized signature”, a $25.00 fee will be assessed to your account. We may choose to proceed with legal action which will result in additional fees to you or the guarantor of the account. You are responsible for the additional fees. If it is necessary to cancel your scheduled appointment, we request that you notify us at least 48 hours prior to the appointment. A “no-show” is someone who misses an appointment without cancelling it at least 48 hours prior to the scheduled appointment time. A failure to present at the time of a scheduled appointment will be recorded as a “no-show”. You will be charged $25 50 for “no-show” appointmentsoffice visits; $100 for ultrasounds and $200 for procedures. There is a $25.00 45.00 charge for each FMLA/disability form/signature completed by this office. Payment is due at the time the form is submitted. All FMLA/disability forms are completed by the office staff. There is generally a 7-14 day waiting period for the completion of these forms. The physician’s documentation in your medical chart serves as the basis of all FMLA/disability forms and cannot be enhanced by yourself or the office staff. It is important that you understand the difference between FMLA and disability forms. Disability forms can only be completed after the physician has determined the patient has a medical condition that warrants the patient to be off work. Normal symptoms during pregnancy (nausea, vomiting, headaches, swelling, pelvic pain/pressure) do not typically qualify as a medical disability.

Laboratory Services. Your physician may order laboratory services to assist in diagnosing your condition or as preventative care to determine your current health status. Your WHASN care centers may utilize the WHASN Central Laboratory for the ordering and processing of specimens and/or cultures; however, your insurance benefits may not cover all services provided or ordered by the provider. This includes: includes pap smears, testing for sexually transmitted disease, screening and diagnostic labs, genetic testing testing, and drug screening. In some instances instances, these services may be applied to your annual deductible or not covered. It is the patient’s responsibility to know the coverage, limitations and exclusions of your insurance policy. If you know that your insurance will not cover lab processing unless you go through a specific lab company, or you have a preference on the lab company you’d like to use, please notify office staff of your and/or your insurance’s lab preference. Please note that if you’d like to discuss lab results, you may need to be scheduled for an appointment and that this appointment may also require additional visit costs (with self-pay or co- pay rates). WHASN’s central billing office Central Billing Office (CBO) accepts checks as payment on an account. In the event a check is returned by the bank for “non- non-sufficient funds”, “closed account”, “return to maker”, “check voided”, “stop payment” and and/or “un-authorized signature”, a $25.00 fee will be assessed to your account. We may choose to proceed with legal action which will result in additional fees to you or the guarantor of the account. You are responsible for the additional fees. If it is necessary to cancel your scheduled appointment, we request that you notify us at least 48 hours prior to the appointment. A failure to present at the time of a scheduled appointment will be recorded as a “no-show”. A “no- show” is someone who misses an appointment without cancelling it at least 48 hours prior to the scheduled appointment time. A In addition to being marked as a no-show, the failure to present at notify our office within the time of a scheduled appointment 48-hour period will be recorded as also result in a “no-show”” fee, which may vary depending on the type of appointment that you are scheduled for (i.e., regular visit, ultrasound, procedure, etc.). You If you have questions regarding fees that will be charged $25 charged, please reach out to the care center for “no-show” appointmentsmore information. FMLA - There is will be a $25.00 charge for each FMLA/disability form/signature completed by this office. Payment is due at the time the form is submitted. Note that the charge is non-refundable, should the patient change their mind. All FMLA/disability forms are completed by the office staff. There is generally a 7-14 day waiting period may be the option of having the paperwork expedited, but please note that there are additional fees due for the completion of these formsexpedited form completion. Please note: The physicianprovider’s documentation in your medical chart serves as the basis of all FMLA/disability forms and cannot be enhanced by yourself or the office staff. It is important that you understand the difference between FMLA and disability forms. Disability forms can only be completed after the physician provider has determined the patient has a medical condition that warrants the patient to be off work. Normal symptoms during pregnancy (nausea, vomiting, headaches, swelling, pelvic pain/pressure) do not typically qualify as a medical disability. If you have questions regarding any amount(s) that will be charged or timelines to complete these forms, please reach out to the care center for these details.