East Lincoln Family Health Professionals, PC thanks you for choosing us as your healthcare provider. ELFHP considers it a privileged responsibility to be chosen as your health care providers. This is a trust that does not come easily, and we will make every effort to ensure that your trust is well placed and your confidentiality be protected.
We agree to:
- Provide you with the best evidence-based care we can, in a timely and cost-effective manner.
- Return your calls as quickly as possible, and to take adequate time to understand your specific problems and when necessary, arrange for all referrals to specialists and testing facilities.
- Be responsive to your constructive criticism in an attempt to continuously improve our services.
We are committed to building a successful physician-patient relationship with you and your family. Your understanding of our policies is important to our practice-physician-patient relationship. Please understand that payment for services is a part of that relationship. We ask that if you have any questions about our fees, our policies, or your responsibilities to please ask the office. It is your responsibility to notify our office of any patient information changes (i.e. address, name, insurance information, etc).
You have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- For services scheduled three or more days in advance, you are entitled to a Good Faith Estimate via MyChart, email or mail. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate:
The name of the state law is Out-of-Network Emergency Medical Care Act.
For questions of more information, please contact:
These policies help the office provide quality care to our valued patients.
If you have any questions or need clarification of any of the above policies, please feel free to contact us.
I agree to abide by the policies of the office and understand that if I do not, I may be asked to seek care elsewhere.
Acknowledgement Signature Required on Demographic Form.
East Lincoln Family Health Professionals, PC. RESERVES THE RIGHT TO CHANGE AND/OR MODIFY THE INFORMATION ON THIS SITE AT ANY TIME.