Primary Care Policies

1Consent to Treatment & General Practice Policies

PrimeCare is not an emergency facility. For life-threatening or emergency concerns, call 911 or go to the nearest emergency department.

Your physician or healthcare provider will explain the risks and benefits of treatment, and you will have the opportunity to ask questions and discuss your treatment plan.

PrimeCare strives to provide quality care based on accepted standards of medical practice; however, treatment outcomes cannot be guaranteed.

PrimeCare participates in the Virginia Prescription Monitoring Program, which may be reviewed before prescribing controlled substances.

PrimeCare may use a secure ambient artificial intelligence (AI) scribe to assist with documentation of your visit. The tool may transcribe portions of your visit into your medical record to support accurate documentation. The system is designed to comply with HIPAA requirements, and audio is not stored or used outside of your medical record.

PrimeCare reserves the right to refuse non-emergency services for threatening, intimidating, abusive, disruptive, or otherwise inappropriate behavior.

2Patient Responsibilities

As a patient of PrimeCare, you are responsible for:

• Providing accurate and current medical, contact, insurance, and pharmacy information.
• Actively participating in your care and following treatment recommendations.
• Informing your healthcare provider of significant changes in your health.
• Following PrimeCare’s communication and Patient Portal policies.
• Maintaining recommended follow-up appointments for chronic conditions, medication management, and other ongoing healthcare needs.
• Understanding and complying with the appointment, insurance, billing, and financial policies outlined below.

3Appointments, Check-In & Attendance

Arrival Time

Patients are expected to arrive 10–15 minutes before their scheduled appointment time to allow adequate time for check-in and clinical triage.

Failure to arrive early may reduce the amount of time available for your visit or may require your appointment to be rescheduled. Patients arriving after their scheduled appointment time may be asked to reschedule.

Digital Check-In

PrimeCare utilizes Digital Check-In to streamline the registration and check-in process. Patients should complete Digital Check-In before arriving for their appointment.

If Digital Check-In has not been completed in advance, you must arrive at least 10–15 minutes before your scheduled appointment to allow sufficient time to complete registration, check-in, and triage. Failure to complete required check-in procedures in sufficient time may result in rescheduling.

Appointment Confirmation

Appointments must be confirmed at least 24 hours before the scheduled appointment time. Appointments that are not confirmed may be automatically canceled by the scheduling system.

Missed Appointments & Late Cancellations

4Communication & LEAP Patient Portal

General Communication

Email and Patient Portal messaging are intended for routine, non-urgent communication only. Messages are reviewed during normal business hours and are typically answered within 2–3 business days. If you have not received a response within 3 business days, please call the office.

Phone calls are returned during office hours as soon as reasonably possible, generally within the same 2–3 business-day timeframe depending upon the nature of the request.

Do not use email or the Patient Portal for urgent or emergency concerns. For a medical emergency, call 911 or go to the nearest emergency department.

LEAP Patient Portal

The LEAP Patient Portal is intended for routine, non-urgent communication between scheduled visits. Please do not use the portal for:

• Urgent concerns.
• New or worsening symptoms.
• Multiple medical concerns in one message.
• Daily updates or frequent check-ins.
• Continuous monitoring or coaching.
• Ongoing management of a medical problem requiring clinical follow-up.
• Issues requiring a comprehensive medical evaluation.

These concerns may require a scheduled office, telehealth, or other appropriate visit.

Medical Decision-Making Through the Portal

Depending upon the nature and complexity of the issue, your provider may determine that an office or telehealth appointment is required instead of managing the issue through electronic messaging. Administrative questions and scheduling requests are not considered medical decision-making.

5Prescription & Medication Policies

Prescription Refills

Prescription refills are provided during scheduled office visits.

The only exception is for patients who have a provider-approved three-month maintenance refill plan.

It is your responsibility to schedule the appropriate follow-up appointment before you run out of medication.

We understand that patients may occasionally experience an unexpected gap in medication. If you believe you need a temporary gap refill, contact our office. We will review your medication and determine the appropriate next step, which may include scheduling an appointment before any refill can be authorized.

Chronic Medication Management

Chronic medications require regular medical follow-up as directed by your healthcare provider. Depending upon your medical condition and medication, follow-up may generally be required every 3–6 months or at another interval determined by your provider.

Controlled Substances

Controlled substances are subject to additional monitoring and prescribing requirements. PrimeCare may review Virginia Prescription Monitoring Program information before prescribing controlled substances.

Patients receiving controlled substances may be required to maintain a current Controlled Substance Agreement and comply with all required follow-up, monitoring, testing, and prescribing requirements.

6Laboratory Testing & Communication of Results

Lab Work Before Your Appointment

If your provider has ordered laboratory testing or other diagnostic testing to be completed before your scheduled appointment, the testing must be completed at least 7 days before your appointment whenever instructed.

Testing completed too close to the appointment date may not be resulted and available for your provider to review during your visit.

Communication of Results

Routine results are generally released through the Patient Portal within 3–5 business days after they are received and reviewed.

Urgent or significant findings will prompt direct telephone contact in addition to Patient Portal communication when appropriate. If repeated attempts to contact you are unsuccessful, written notification may be mailed.

Results are not released through voicemail or unsecured email without appropriate authorization. You are responsible for contacting the office if you have not received your results within 7 business days.

7Telehealth & Telephone Visits

You consent to receive healthcare services through telehealth or telephone visits when clinically appropriate and permitted by PrimeCare.

Telehealth visits generally involve both audio and video communication. Telephone visits are audio-only and may be used in limited circumstances at the healthcare provider’s discretion. Remote visits are provided at the sole discretion of the healthcare provider based upon whether remote care is clinically appropriate.

Virginia Location Requirement

Telehealth services may only be provided when you are physically located in the Commonwealth of Virginia at the time of your visit. You agree to accurately report your physical location.

Limitations of Remote Care

Telehealth and telephone visits have limitations and may not permit a complete physical examination or full medical assessment. Your provider may require an in-person office visit, urgent care or emergency evaluation, laboratory testing, imaging, other diagnostic testing, or specialist evaluation.

Technical problems, poor internet connectivity, audio/video failure, or interrupted calls may require the appointment to be rescheduled or converted to another type of visit.

Telehealth and telephone visits are not appropriate for medical emergencies.

Telehealth Billing

Telehealth and telephone services may be billed to your insurance and/or directly to you. You are responsible for applicable co-pays, deductibles, co-insurance, non-covered services, and self-pay charges.

8Wellness & Preventive Exams

A wellness exam is a preventive visit focused on routine health maintenance, age-appropriate screening, preventive counseling, and other preventive services. It may also be called an annual physical, preventive visit, annual exam, routine check-up, or well-woman examination.

Preventive vs. Problem-Oriented Care

A preventive examination does not necessarily include evaluation or treatment of new medical concerns, new or worsening symptoms, significant medication problems, detailed management of chronic medical conditions, or other problems requiring separate medical evaluation or decision-making.

PrimeCare recommends scheduling preventive and problem-oriented visits separately whenever possible. If new or ongoing medical problems are evaluated or managed during your wellness examination, an additional problem-oriented service may be billed in addition to the preventive examination.

Insurance Coverage

Many insurance plans cover one preventive examination per year; however, individual plans vary. Preventive visits may be limited by calendar year or may need to be separated by a specific number of days. If you have already received a preventive examination within your plan’s permitted timeframe, your insurance company may deny coverage.

Not all laboratory testing, imaging, procedures, or diagnostic services ordered during a preventive examination are considered preventive benefits and may be billed separately. You are responsible for understanding and verifying your insurance coverage and eligibility.

9Medical Records & Care Coordination

You authorize PrimeCare to request, obtain, use, and share relevant medical information and medical records with healthcare providers and organizations involved in your care when reasonably necessary for treatment, continuity of care, and healthcare operations.

This may include communication with primary care providers, specialists, hospitals, laboratories, imaging facilities, pharmacies, and other healthcare organizations involved in your care. Medical information will be handled in accordance with applicable privacy laws and HIPAA requirements.

10Insurance, Billing & Financial Responsibility

Insurance Participation & Claim Filing

If PrimeCare participates with your insurance plan, PrimeCare will submit claims as a courtesy when complete and accurate insurance information has been provided.

You assign to PrimeCare healthcare benefits payable to you under your insurance policy and authorize direct payment of those benefits to PrimeCare as permitted by law. Submitting a claim, verifying benefits, receiving an authorization, or receiving payment from your insurance company does not eliminate your financial responsibility.

Patient Responsibility for Insurance Coverage

Insurance plans, networks, benefits, and coverage requirements change frequently. You are responsible for understanding your individual insurance coverage, including:

• Whether PrimeCare and the individual healthcare provider participate with your specific plan.
• PCP selection, referral, and prior authorization requirements.
• Covered and non-covered services and benefit limitations.
• Deductibles, co-pays, co-insurance, and in-network or out-of-network benefits.

PrimeCare may assist with eligibility or benefit verification as a courtesy. Verification is not a guarantee of coverage or payment and does not guarantee that PrimeCare, a specific provider, service, laboratory, or facility is in network. If PrimeCare does not participate with your plan, you may be considered self-pay unless other arrangements have been approved in advance.

Referrals & Prior Authorizations

If your insurance plan requires a referral or authorization and the required approval is not obtained before your visit or service, you are responsible for charges not paid by your plan.

Certain medications, testing, imaging studies, treatments, and procedures may require insurance approval. PrimeCare will submit required clinical information when appropriate, but decisions and processing timeframes are determined by your insurance company or pharmacy benefit manager.

You are responsible for verifying coverage, responding promptly to insurer and pharmacy communications, and completing requirements requested by your plan. You authorize PrimeCare to submit prior authorization requests, reconsiderations, and appeals when appropriate.

Services That May Be Billed

Billable services may include in-person and remote services such as provider visits, nursing services, counseling, patient education, after-hours services, chronic care management, care coordination, telephone and telehealth services, Patient Portal communication involving medical evaluation or decision-making, and other medically necessary services.

Payment Responsibility

Patients are responsible for all applicable co-pays, co-insurance, deductibles, non-covered services, self-pay charges, outstanding balances, and delinquent balances.

Payment is generally due at the time of service, with additional patient responsibility due after insurance processing or as otherwise indicated on your account. Returned checks are subject to a $50 returned-check fee.

Automobile Insurance & Workers’ Compensation

PrimeCare does not submit claims directly to automobile insurance carriers. If a workers’ compensation claim is denied, charges may be submitted to the patient’s private health insurance when applicable and permitted.

11Financial Responsibility for Minors

The parent, guardian, or responsible adult who accompanies a minor patient to the office is financially responsible for payment for services provided, regardless of divorce decrees, custody agreements, agreements between parents, or which parent carries the health insurance policy.

PrimeCare is not responsible for enforcing private financial arrangements between parents, guardians, or other responsible parties.

12Insurance Information & Coordination of Benefits

You agree to cooperate with reasonable requests from PrimeCare and your insurance company related to claim processing. This includes providing complete and accurate insurance information, providing requested additional information, completing Coordination of Benefits requirements, responding to insurer questionnaires, and complying with reasonable payer requirements.

If a claim is delayed, denied, unpaid, or later adjusted because of incomplete information, failure to respond, failure to complete Coordination of Benefits, or failure to comply with insurance requirements, you are responsible for the resulting balance.

If your insurer later retracts, reverses, adjusts, or recoups a payment for a valid reason, even after significant time has passed, you remain financially responsible for the resulting patient balance.

13Forms, Letters & Administrative Services

Completion of forms and extensive letters may require administrative and/or medical review. Examples include FMLA paperwork, disability forms, employment forms, extensive medical letters, and other documents requiring substantial chart review or provider completion.

A fee of approximately $25–$50 may apply depending upon the complexity of the request and is payable at the time of request. Requests requiring extensive medical review, evaluation, or medical decision-making may require a scheduled appointment.

Typical turnaround time is approximately 5–7 business days.

14Patient Balances, E-Statements & Collections

Patient balances are due within 30 days unless a payment arrangement has been approved in advance.

Statements, balance notifications, and payment reminders may be provided electronically through text message, email, the Patient Portal, or other approved electronic communication methods. You are responsible for keeping your mailing address, telephone number, email address, and insurance information current. Paper statements may be subject to a small mailing fee.

Delinquent Accounts

Payment arrangements must be made directly with the office before the account becomes delinquent.

If an account is referred to an outside collection agency, a $50 administrative fee may be added for each date of service referred to collections, in addition to reasonable collection expenses, legal fees, court costs, interest, and other amounts permitted by law.

15Outside Laboratory & Third-Party Charges

Outside laboratories and other third-party healthcare entities may bill separately for their services. You are responsible for charges assessed by those entities, including any applicable deductible, co-payment, co-insurance, non-covered service, or other patient responsibility determined by your insurance plan.

16Text Message & Email Communications

By providing PrimeCare with your mobile telephone number and/or email address, you consent to receive communications related to your healthcare and account. These may include appointment reminders and confirmations, scheduling information, billing notices, account updates, Patient Portal notifications, and other important health-related or administrative information.

Message and data rates may apply to text messages. You may opt out of non-required text communications by replying STOP when that option is provided. You may unsubscribe from applicable email communications using the unsubscribe link in the email.

Consent to receive text or email communications is not a condition of receiving medical care or services from PrimeCare.