Miscellaneous Resources

In order for us to prepare appropriately for your visit, it is your responsibility to:

• Bring your insurance card(s) to your appointment.
  
• Bring your insurance copayment which is due at the time of service. For your convenience, we accept VISA and MasterCard.
  
• Obtain a referral from your primary care physician. If your insurance requires a referral, please bring it with you or arrange to have your physician's office send or fax it to 603-641-0360 in advance of your appointment. Without your referral, you will need to sign a waiver for your visit.
  
• Obtain pertinent medical records, x-rays, MRIs, or scans previously completed for this condition.
  
• Complete the Patient History Form and bring it to your appointment (see below for online form)
  
• Review and sign the Combined Consent Form and bring it to your appointment (see below for online form)
  
• Review the Notice of Privacy Practices (see below for online form)
  

We participate with most of the major health plans. Please check with your insurance carrier if you are unsure whether we participate with your plan or not. We will bill your insurance carrier as a courtesy to you; however payment for deductible and co-pay is due at the time of service. This includes all office visits, procedures, and injections as well as durable medical equipment. If you do not have your co-pay with you, your appointment may be rescheduled. Please remember…Your insurance coverage is a contract between you and your insurance company and not a substitute for payment

We will bill the insurance carrier for patients with accepted claims under Workers' Compensation. It is necessary for you to provide the name and address of your insurance company and your case number.

Self pay accounts are for patients that have no insurance coverage, or are covered by plans we do not participate with. Payments must be made at the time of service. If you do not have your payment with you, your appointment may be rescheduled.

If your insurance requires a primary care physician (PCP) to provide an authorization to a specialist, it is your responsibility to make sure that you obtain that referral prior to your visit. If authorization is not provided, you will be asked to either reschedule your appointment or pay for your visit in full at the time of service.

Effective July 13, 2007, the governor signed into effect a law that precludes medical providers from being directly reimbursed by motor vehicle liability policies. It is now our policy that these services will be considered Self Pay and must be paid at the time of service. We will provide you with documentation that you can use to get reimbursed from your carrier. If you do not have your payment with you, your appointment may be rescheduled.

If you have a medical insurance that we participate with, we will bill your insurance company. For identification and billing purposes it is our policy to require our patient to provide their social security number, as well as a driver’s license, in addition to providing your insurance card at each visit. If you have an insurance that we do not participate with, you are expected to pay in full at the time of your visit and we will give you paperwork so that you may submit your claim and be reimbursed. If you have no insurance, payment in full is expected at the time of your visit. We accept cash, checks, Master Card, Visa and Discover.

ALL CO-PAYMENTS ARE EXPECTED TO BE PAID AT THE TIME OF SERVICE.

It is the policy of this office to request prepayment for all deductibles and co-insurance not yet met, two weeks prior to your surgery date.

Someone from the Billing department will estimate your out of pocket cost based upon the surgery discussed and your insurance benefits, once verified. This will be an estimate of NHOS charges only based upon anticipate procedures as booked, as alternate procedures may be necessary or change during the surgical case. The Billing department will contact you either by mail, if time allows, or by phone to inform you or your out of pocket responsibility.

Payment of your estimated cost share will be expected in advance of your surgery and may be made with cash, check or credit card over the phone.

We ask that you anticipate any necessary drug refills and call in advance, as requests for prescription refills will only be taken during office hours before 3:00 p.m. We also require a 48 hour notice for your prescription refill and cannot acknowledge your call on weekends, on holidays or on on-call nights.

If you want copies of your medical records or x-rays sent to another physician, we require your signed authorization for release of records. At least 5-7 days notice is appreciated when requesting a copy of your record.

X-rays are an important diagnostic tool for your physician. As a convenience to our patients, N.H. Orthopaedic Surgery, P.A. has a fully equipped x-ray department. If x-rays have previously been taken, we request that you bring these along for your visit. These will be helpful to your physician and may eliminate the need for additional films. Simply request these ahead of time and pick them up at the doctor's office or hospital where they were taken.

To ensure a proper recovery, we have provided documents below to outline important things to keep in mind following a knee surgery, or any surgery, that requires a cast.