Thank you for choosing Southside Diabetes for your healthcare needs!

Please bring the following items to every visit at Southside Diabetes:

1. Picture ID – to reduce your risk of medical fraud
2. All insurance cards, including your pharmacy card – to ensure accurate billing and medication approvals
3. Credit card for copayments, deductibles, and account balances – to maintain your contractual agreement with your insurance company and our practice
4. Current, updated medication list – to ensure accuracy in your medical record
5. All diabetes devices, including insulin pumps and glucose readers – to enable us to provide you with the most comprehensive care possible

Please carefully review our office policies prior to your appointment:

• ALL copayments, deductibles, and account balances are due on arrival for your visit and PRIOR to seeing the healthcare provider.
  1. Copayments cannot be waived. Copays are contractual agreements between you and your insurance company, as well as between Southside Diabetes and your insurance company. If we do not collect your copay, you and SSD are both in breach of contract with your insurance company. Your insurance company is then entitled to cancel your coverage, drop our contract, and you will be responsible for the cost of the entire visit.

• Same-day cancellations and no-shows will result in a $50 fee, which must be paid prior to rescheduling your visit. Please review our No Show & HIPAA Policy [here]; copies are available upon request.
  1. Life happens; we get it. Please remember that failure to arrive for your office visit leaves a 20-40 minute gap in our schedule, resulting in loss of revenue for SSD. The office does not stop operating because you forgot your appointment; therefore, we must assess a small fee to recuperate a fraction of the revenue lost from your office visit.

• We will verify that your insurance is active prior to each visit. If your insurance is inactive, you will be considered Self Pay and required to pay the self-pay rate PRIOR to being seen.
  1. New Patients: $175
     1. Includes capillary finger stick and blood glucose, point of care HgbA1c, 40-minute office visit
  2. Follow Up Visits: $125
     1. Includes capillary finger stick and blood glucose, point of care HgbA1c, 20-minute office visit
  3. Not Included: professional sensors, lab work, medications.

• A signed Financial Agreement (Assignment of Benefits) is REQUIRED for all patients prior your appointment. This agreement also authorizes Southside Diabetes LLC to keep your credit card on file. Please review our Financial Agreement [here]; copies are available upon request.
  1. This agreement protects you, the patient, and us, your healthcare provider. We will bill your insurance plan, but ultimately the responsibility for your insurance plan and all outstanding balances lie with you. Your insurance plan is yours. Medical practices bill your insurance as a courtesy. We encourage you to be educated about your insurance plan; you must call them directly with all questions related to billing and coverage.

• The following consents are required to be signed and on-file for all patients:
  1. Financial Policies Agreement (Assignment of Benefits)
  2. HIPAA & No Show Policies
  3. Notice of Privacy Practices
  4. Telehealth Consent

We have made our office policies transparent and accessible to help you avoid any surprises that may arise from your visit to our office. We also hope it helps you to understand your role in your healthcare, including your responsibilities with your insurance company. Please do not hesitate to contact your plan or our office if you have questions. We look forward to seeing you!