Frequently Asked Questions

Check out our FAQs below. You may find your answer right here. If not, we invite you to send us an inquiry or give us a call.

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Are you accepting new patients?

Yes. We hold appointments open every day so our existing patients can be seen when needed, so we may ask new patients to wait a few weeks before their first appointment, but we look forward to welcoming you to our practice.

What is the difference between seeing a MD and a Nurse Practitioner?

Nurse Practitioners are highly trained medical providers who are qualified to take care of the full scope of care we offer. You will receive the same quality of medical care from all of our providers at Ponce Primary Care.

Do you have parking?

Yes. Our driveway to the right of our practice is somewhat narrow so drive carefully, but we have free parking directly behind our building with direct access to our practice. Please do not park in our neighbor businesses’ parking lots. Street parking in Decatur during the day is limited, but it is rare for our parking lot to be completely full during normal office hours.

“Wellness visit” or “Annual Physcials” – how are these different than other visits? Why do I need one and how often?

We ask most patients to see us once a year for a visit focused on prevention issues. For some younger patients in good health, these visits can occur every couple of years. Insurance companies generally allow one such visit per year which is not subject to copays and deductibles (there are insurance exceptions). It is usually not possible to cover the full range of indicated screening tests, lifestyle recommendations, immunizations etc. while also addressing medical problems during a single visit.

For patients with chronic medical conditions, we ask that you plan on at least one additional visit per year that is “problem-focused” (i.e. we’ll work closely on your medical problems as we’ve covered the prevention topics at your annual physical/wellness appointment). Like other visits for medical problems, these visits focused on your chronic medical conditions are generally not exempt from copays and deductibles with your insurance.

Sometimes it is possible to address both problems and prevention at the same visit. When this is done, and it depends on the time required for both, the claim submitted to your insurance will reflect that both services were provided. Copays and deductibles apply to the portion of the claim reflecting the medical problem work. In short, insurance policies require us to submit claims that reflect all of the care provided. Care for either chronic or acute medical problems is not part of any “annual visit” care for which copays and deductibles don’t apply. This is not our policy but rather the structure of insurance reimbursement rules.

What age patients do you see?

We see patients ages 10 and up in our practice.

Do you accept my insurance?

Please click here for a complete list of insurance plans for which we are in network. Please click here for information regarding our patients without insurance or those with insurance for which we are out-of-network.

How do I pay my bill?

Please go your Patient Portal to pay any outstanding balances. We can also accept payment when you are in the office. You can also mail us a check with a copy of your invoice. Please do not call the office to provide credit card payment over the phone except when absolutely necessary. We get a lot of calls and want to prioritize medical care over all else. Finally, we prefer credit card or check payments over cash for all payments including day of service copays.

What are prior authorizations? How do you handle them?

Insurance companies often require “Prior Authorizations” (PAs) before covering a medication which is not on their preferred medication list (i.e. their “formulary”). These are also often required for controlled substance medications. Patients are usually informed by their pharmacy when a PA is required. Our practice then needs to submit information to the insurance company to justify the need for the particular medication. Patients often assume that this is a quick process in which we simply tell the insurance company to cover the medication. We wish it was that simple. We often must review records to determine whether less costly medications have been tried in the past. Often the needed information isn’t available to us as patients were prescribed the medication before establishing care here. In this common situation, we require an appointment to consider all options including other medications. Forms must then be completed (sometimes in paper format) and submitted to the insurance company.

Please be patient and plan ahead by getting your prescriptions refilled before you run out of medicine. The typical turnaround time for a Prior Authorization is 5 to 7 days and can be longer depending upon the insurance company. We process a large number of these requests at significant cost to our practice. We cannot guarantee that we will be able to “rush” an “urgent” PA request.

What if my insurance requires an authorization (referral) to see a specialist?

Some insurance plans (e.g. HMOs, PathwayX) require authorization prior to a patient seeing a specialist. If a patient sees a specialist on an ongoing basis, these generally must be reauthorized every 12 months. Requests for these authorizations should ideally be made during an in-office visit to avoid the need for chart reviews, multiple phone calls, etc. It is not appropriate for us to document the need for a specialist visit without understanding the medical condition for which a patient is being referred. We are often asked by patients to complete authorizations for specialist care that was initiated by other doctors’ offices. We typically require visits to discuss such requests. While we usually can get authorization for an urgent specialist referral within a couple of days, we ask patients to be as proactive as possible and understand that we cannot control insurance company response times.

What is your no-show/cancellation/late arrival policy?

We work hard to stay on time in our practice. We also do not double-book appointments as many practices do. Therefore, we take no-shows seriously. We charge a $50 no-show fee for no-shows or cancellations made less than 24 hours before an appointment unless we can fill the appointment. In addition, if a patient is more than 10 minutes late for their appointment, we may need to reschedule as we will not rush through a visit or ask the next patient who was on time to wait. The $50 no-show fee applies when such rescheduling is necessary. Every patient who joins our practice is asked to sign a form stating that they understand and will abide by this policy. Patients who have consistent difficulty keeping appointments or being on time will be asked to find another practice for their care.

I sent my provider a message on the portal. When should I expect a response?

We use our Patient Portal extensively for patient communication. Please click here for a complete discussion on portal policies, etiquette, expectaionts etc.

If I leave a voice message – when will I hear from you?

During normal business hours your call will be returned within an hour. While we make every effort to answer every call, we are a small practice and must prioritize the needs of patients who are in the office at any given time.

How do I get my medications refilled?

Medication refills are best handled during your visits with your provider. Ideally, you and your provider will discuss when you should return to the office for a follow-up visit and you will be prescribed enough medication to make it to that appointment without refills being needed. In the event that refills are otherwise needed, please contact your pharmacy as they can send us an electronic request for an electronic prescription which is the most efficient process. Please allow 2-3 days of processing time. It is best to request refills when you notice that you are within a week of running out of your medication. While the frequency of office visits varies based upon one’s medical condition and exceptions occur, we generally will not refill medications for patients who have not been seen in our office within the past year.

Why are Annual Physicals/Wellness Visits scheduled so far out?

We hold open appointments every day so that we can see our patients with urgent medical needs. Prevention-focused visits are by definition not urgent, so we ask patients to schedule them in advance (typically a couple of months). This allows us to manage our appointment slots so that when you are sick we can see you in a timely manner.

Do I need to fast for my visit?

The simple answer is that it depends. Many patients do not need to be fasting for their annual physicals as non-fasting cholesterol panels and blood glucose measurements can be reasonably interpreted. However, for patients at risk for diabetes (overweight, previous abnormal blood sugars) or for patients with known cholesterol elevations we ask that you fast for 12 hours prior to your physical. In the past, most practices including ours asked nearly all patients to be fasting for routine blood work. This has been shown to be unnecessary for many patients so we’ve adjusted our approach. If it is determined at your visit that fasting labs would be valuable and we didn’t ask you to fast this is not a big deal. We can get you back in another morning for blood work only.

Can I get my labs ordered before my visit so my provider has the results when I see her/him?

While this may sound efficient, it usually leads to either excessive or insufficient testing. There is no standard “set of labs” that are appropriate for every patient. Your medical history, lifestyle, age, family history and symptoms all contribute to the decision on what tests to order at the time of your visit. It is more efficient to have follow-up either via our patient portal or when appropriate in person on tests that were well considered before being ordered, than to have to add tests to an incomplete set or interpret results that are not relevant to your medical situation. We make exceptions, but in general prefer to order tests at the time of the visit rather than ahead of time based upon likely incomplete information.

Do you offer telemedicine or virtual visits?

We now offer “virtual visits” (i.e. telemedicine) visits in appropriate circumstances. This is an option only for established patients whom we know well and only when a physical exam and vital signs can reasonably be expected to be unnecessary. Please click here for more information about our Telemedicine service.