Patients will be required to complete and acknowledge the following forms:
o JCMG Notice of Privacy Practices—HIPAA
o Consent for Treatment, Release of Information and Financial Obligation
o Patient Registration
o Patient Health Information
It is the patient’s responsibility to provide JCMG with their insurance billing information at the time of service. Insurance and pharmacy cards will be copied as needed, but verified at each visit.
If a patient’s insurance company requires a referral, it is the patient’s responsibility to request the referral from their primary care physician. Patients unable to secure the referral prior to the visit will be asked to sign a form acknowledging that they may be financially responsible.
The patient’s insurance plan may require a prior authorization for certain radiological or surgical procedures. Approval is required by most participating plans. Patients that request a procedure, which has not been authorized,will be asked to sign a statement of patient responsibility.
Patients presenting with job-related injuries need to inform the front office staff at time of visit that the injury is job-related. A call will be made to the employer to verify approval of services and obtain appropriate billing information.
JCMG does not become involved in third-party disputes. Per your request, JCMG will file these charges with your medical insurance.
Financial responsibility for minors (children) will be based on the individual who signs the form at the initial patient registration. In the state of Missouri, both parents ultimately are responsible for paying a child’s health-care expense.
Minors should be accompanied by a parent/guardian. When this is not possible, the accompanying adult or older child who comes alone needs to have a signed, date-specific authorization from the parent/guardian allowing treatment. If a signed authorization is not available, a call will be made to receive verbal approval from the parent/guardian and verified by two witnesses. The minor will not be treated without parental/guardian written or verbal approval.
JCMG Medical Building Hours
JCMG Medical Building is open 7 a.m. to 6 p.m., Monday through Friday. Individual office hours may vary by department or location.
JCMG Extended Care is open 9 a.m. to 2 p.m., Saturday and Sunday and holidays, except Easter, Thanksgiving Day and Christmas Day.
After Hours Accessibility
Patients should call their physician’s office and the on-call physician will be paged.
At the patient’s request, a copy of the advance directive
will be placed in the medical record. For a copy of the
advance directive packet, please click here.
Our policy requires that you provide 24 hour notice when you are not able to keep a scheduled appointment. You will be notified if you have two or more missed appointments.
Comments or Suggestions
JCMG welcomes your thoughts for continued quality
improvement. Please use any of the following for
issues or concerns:
1. Billing issues contact the Billing Office
2. Clinic related issues contact the Department
Coordinator or Quality Coordinator
3. Suggestion box in the Lobby of the JCMG
4. Contact us at: firstname.lastname@example.org