Below is a sampling of questions often asked by our patients, along with the kind of response you can anticipate. You’ll want to take time to develop your own list of questions, or concerns, to review with the doctor on your first visit.
"This place is my second home , they treat all my family with love. The staff is amazing very concerned about the health of the patient. I will recommend this place to everyone."
WMC Patient Basics
What is expected of me as a WMC patient?
At Windermere Medical Center, we practice patient-centered, preventative care. This means we do regular check-ups, counseling and screenings to prevent illness and disease progression. We also manage diseases or conditions with routine visits including labs and imaging if needed. As a Windermere Medical Center patient, you will be expected to be involved in your healthcare and adhere to preventative care and disease management policies. This includes regular visits and routine to manage your disease. In addition, you will also be expected to follow age specific screening recommendations such as cervical cancer screening (PAP), colon cancer screening (colonoscopy), breast cancer screening (mammogram) as well as an annual physical in order to maintain active status as a patient. If you do not believe in preventative care or are looking to manage your medical conditions by only coming once a year, Windermere Medical Center is not the practice for you.
Why did my medication refill get rejected?
If your pharmacy sent a refill request or you called for a refill and it was rejected, it is likely because you missed your previously scheduled follow-up visit. It also may indicate that they are due for bloodwork if you have any chronic conditions that need routine blood monitoring. We always outline the expectations for follow up appointments when the medication was prescribed. Please see below for some examples of condition follow up:
- Controlled substances – every 3 months, labs every 6 months
- Blood pressure/cholesterol/depression meds/Thyroid/diabetes – a visit every 3-6 months with labs. The frequency of your visits is determined by your provider.
- Testosterone/PrEP – visit and lab every 3 months
You can get a short term medication refill (7-30 days) on the walk in side but you will be expected to make your regular follow up visit and labs that day may be required of you.
Why do I have to pay for a prior authorization?
All insurances do not cover all medications in the same manner. We prescribe generics and lower cost medications when we can. However, if your condition or preference requires a brand name medication, your insurance may not cover it. We can attempt to get an authorization for this medication but this process takes time and resources. Although we initiate this process, there is no guarantee that your insurance will approve the medication. For the time spent, we charge a $50 prior authorization fee per medication per year, regardless of approval.
How is WMC Walk-in different from another urgent care?
We are not an urgent care facility. We are a primary care office that offers walk-in services both for our established patients as well as other patients in the community. This is especially beneficial for our established patients because they are able to see the same care team they would during a regular visit. They have access to your health history and can safely develop a treatment plan while considering your conditions. Since we are not an urgent care, we do not bill as an urgent care so the financial responsibility is the same as being seen as a primary care patient. You will be responsible for your co-pay or deductible. However, it may be more cost efficient for you to be seen here on our walk-in clinic as your urgent care co-pay may be more than your PCP co-pay (which is what is collected for a walk-in visit)
Why is the wait so long on walk-in side?
Our walk-in clinic is staffed by one nurse practitioner or PA. The visits are first come first serve, unless there is a patient that warrants more immediate attention. The wait times are dependent on the volume of patients and the resources each patient requires, neither of which are predictable. An estimated wait time is given at check in and we strive to adhere to that time.
Why do you need vaccination records? Why don’t you see unvaccinated children?
Windermere Medical Center follows the recommendations of the American Academy of Pediatrics and the Centers for Disease Control and Prevention, as such we do not see children that are unvaccinated. This both for the safety of the unvaccinated child as well as the patients in the practice.
Why haven’t I been called with imaging/labs as discussed in the visit?
The turnaround time for testing depends on the time you had your test and the type of test done. For routine imaging and labs, we expect around 7 days for the office to receive the results. All imaging is reviewed by a provider within 5 days then the nurse will call with the results. Please note, all abnormal imaging that needs immediate attention is typically called same day by the imaging facility to a provider and the patient is made aware.
Do you offer dermatology services?
Yes. We offer in office dermatology services by our Dermatology Nurse Practitioner, Michael Frasure, on select days of the month for our established patients ages 5 and over.
Appointments
Why can’t I schedule a physical for my first visit?
The first internal medicine visit is to allow the provider to go over all your health history and address any immediate medical needs. This may include medication refills, referrals or acute conditions that need to be managed first. There are instances where the first visit may be converted to a physical. This is at the discretion of the provider and only during the establishment visit, after the provider has determined that no immediate needs need to be addressed.
Does my walk-in visit count as an establishment visit?
Not necessarily, the walk-in visits are to address the acute condition that you were seen for. If the walk-in provider determines that your next visit can be a physical, they will indicate that to the front desk. Otherwise, your next internal medicine appointment will still be an establishment.
What is a physical?
A physical is an annual wellness exam. Most (not all) insurances cover the cost of this exam. At a physical the provider will go over your health maintenance for the past year. At the physical appointment the provider will make sure you are up to date with your immunizations, your screening exams and reviewing or ordering your annual labs. You are only permitted one “physical exam” visit in a calendar year. All other exams, med refills, referrals done, lab result discussion done during a physical appointment will be subject to your deductible or co-insurance depending on your insurance plan.
Why do I have to wait so long to be seen as an appointment with a provider?
We pride ourselves on the quality of the encounters that we have with our patients. This is why we utilize the services of scribes, to provide personalized, attentive care. This is also why appointments are 20 minutes compared to the 15 minute time slots at other primary care offices. Our providers have a fixed amount of appointment times daily to ensure there is no compromise in appointment quality. As a result, we don’t overbook or squeeze patients in. If you are booking with a specific provider, their schedule may be full at the time you are looking to be seen if you didn’t schedule in advance. That is why it is important to schedule your next visit at the end of your last visit to ensure you are able to follow up with the provider of your choice. However, should you need management, refills, referrals, etc, any of the other providers are able to give you the same quality care as practices are consistent amongst all providers (MD, NP, PAs)
Established patients: Why do I have to follow up after a hospital visit?
Hospitalizations usually results in treatment plan changes, medication changes, follow up with new consultants needing higher level coordination of care. Some insurance plans require us to have these appointments to ensure continuity of care and avoid re-admissions to the hospital. We require all patient to have follow-up appointments with 7-14 days after a hospitalization.
Non-established patients: Why can’t I be seen after a hospital visit?
If you are unestablished (new patient or walk in only) and have been in the hospital this year, either ER or inpatient, we are unable to see you until the next calendar year. If you were an established patient, which means you have had a physical in the last two years, we will see you after a hospitalization because we are able to provide continuity of care. We put resources behind our established patients to assist them in meeting preventative care measures such as routine screenings and management of chronic conditions. Additionally, we provide access to our established patients such as extended primary care hours, access to walk in clinic and advanced urgent care treatment in order to keep our patients out of the hospital and their cost of care low. The completion of preventative care measures combined with keeping care costs low allows us to remain in network with our contracted insurance companies. As such, it is our office policy that we do not see unestablished patients who have been hospitalized because we will not assume that cost of care while we were not your PCP. If you are in need of immediate primary care services, you should have been provided with the number of a referral to follow up with. You can review your discharge paperwork or call the hospital as it should be documented who you were referred to. Otherwise, we are more than happy to see you to become established next year.
Why do I have to have an appointment to get (lab/imaging) results?
Not all labs and imaging require a follow up, it is condition dependent and is on a case by case basis. We strive to review labs and imaging in a timely manner in order to avoid unnecessary visits. However, if you have abnormal labs or imaging, we have a responsibility as your care provider to educate you on your condition and discuss the plan. Additionally, if the labs were from a physical (preventative visit), you will still be subject to your regular office fee for follow up as lab reviews are not considered “preventative”
Why do I need a referral to a specialist?
If you have an HMO, you must get an authorization generated by our office to direct you to specialists in your network. If you have a PPO, you typically don’t need a referral but some specialists require an order from your provider, which requires an office visit.
How long does it take to get a referral?
For routine, not immediate referrals, please allow at least 2 weeks for your referral to be done. This allows for the proper documentation and authorization to be delivered to the specialist. If you have already seen a specialist, it is the responsibility of the specialist office to contact us with the request for referral and supporting office notes. Also, if you have already seen the specialist prior to getting referrals, insurance may not cover the visit as we cannot back date a referral.
Why is my appointment being rescheduled?
We try our best to be mindful of your time and strive to have our schedules available a few months in advance. However, due to the additional hours and days we extend to the patients, our schedules are not set and appointments may need to be changed based on a providers availability.
What steps do I need to take for surgical clearance?
When you are having surgery, your surgeon should have provided you with their surgical clearance requirements. They typically want this with in 30 days of the surgery, whether it be labs, EKG or imaging. You need to plan accordingly to anticipate any delays in your surgery. This means making the surgical clearance form immediately available to our office and scheduling a surgical clearance appointment as soon as possible.
Why do I need a surgical clearance appointment?
Surgical clearance appointments are necessary for multiple reasons. The first of which is to have a continuity of care, as your PCP, we need to be aware of the surgery you will be having in case any complications arise or follow up is needed. The second reason that is usually, the surgical center has specific testing that needs to be completed before the surgery (labs, EKG, imaging). All surgical centers have different requirements.
Why do you stop seeing patients 30-60 minutes before you close?
During the week we do not take new patients after 8:00 pm and we do not take established patients after 8:30 pm. On Saturdays, we do not take new patients after 4:00pm and we do not take established patients after 4:30 pm. This is to ensure that our staff is out in a timely manner at our closing time. We cannot anticipate how the walk in day will progress so there may be times where, due to volume or complexity of condition, the cut off time may be earlier. If you are unable to make it by the time requested, we will be open the next morning at 9 am to accommodate your needs.
Insurance and Billing
What does my insurance cover?
It is the patient’s responsibility to learn about their coverage when they choose a plan. This includes co-pays, deductibles, services covered, lab fees, imaging costs, medications covered etc. We take many insurances and their coverage changes on a regular basis. As a result, we are unable to keep up with those changes. We only order labs or tests that are necessary for screening or disease management, but we cannot guarantee their coverage. You can decline testing but depending on your condition, some labs may be non-negotiable to maintain patient status.
Why did I get a lab bill?
Although physicals are considered preventative and covered 100% by insurance. The screening labs are not always covered at 100%, therefore if you have a deductible or had a test that insurance does not cover, you will be billed for the amount not covered. It is your responsibility to find out what your insurance will and will not cover. We cannot provide that information as the plans change on a regular basis and it would not be possible to give an accurate estimate.
Alternative: If you have a high deductible plan, consider opting for self-pay labs instead of going through your insurance. The fee schedule can be provided for you.
Why did I get a bill for imaging?
We only send patients for imaging when it is clinically indicated or for recommended screenings. Depending on your insurance plan, imaging may or may not be covered and you may owe a portion of this bill, which will come from the imaging facility. It is your responsibility to find out what your insurance will and will not cover.
Alternative: If you have a high deductible plan, consider opting for self-pay imaging instead of going through your insurance. The fee schedule can be provided for you.
Alternative: If you have a high deductible plan, consider opting for self-pay imaging instead of going through your insurance. The fee schedule can be provided for you.
Why is there a $15 lab draw fee?
We charge a $15 convenience fee for labs drawn in our facility to cover the cost of staffing a dedicated phlebotomist. This does not apply towards your deductible and is not part of preventative coverage from insurance. Having an expedited, local lab draw is a service we offer to our patients. You have the choice of going to a lab draw facility such as Lab Corp or Quest, you just have to let your provider know to give you a lab order prior to you checking out.
What is a HMO?
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. HMOs require you to choose a PCP. All referrals to specialists need to be through your PCP. It generally won’t cover out-of-network care except in an emergency.
What is a PPO?
A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. PPOs do not require you to choose a PCP. No referrals are needed to see a specialist. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
What does Co-Pay mean?
A co-pay is a fixed amount you pay for a covered health care service after you’ve paid your deductible (if you have a deductible)
- For example: Your insurance card states $20 co-pay for PCP, you pay $20 at the office visit.
What does Deductible mean?
The amount you pay for covered health care services before your insurance plan starts to pay. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. WMC is a good choice for high deductible plans. Most high deductible health plans come with lower monthly premiums. If you anticipate only needing preventive care, it is covered at 100% under most plans when you stay in-network.
- For example: If you have a $1000 deductible, you will pay out of pocket for your health care expenses until you reach $1000, after that you will only pay a co-pay, co-insurance or nothing depending on your plan.
What does Co-Insurance mean?
The percentage of costs of a covered health care service you pay after you’ve paid your deductible.
- For example: If you’ve already paid your deductible and you have a 20% Co-Insurance, your insurance is billed $100, you will be responsible for $20 of the bill.
What does Out-of-pocket maximum/limit mean?
The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits.
