Primary Policy Details

Secondary Policy Details

Pharmacy

1. CONSENT FOR TREATMENT & LAB WORK

I consent to necessary treatment, including drugs, medication, performance of laboratory testing, imaging, or other studies that may be used by Lyons Primary Care Group's clinical providers and staff.

2. RELEASE OF INFORMATION & ELECTRONIC PRESCRIBING CONSENT

Release of Information

Some or all information in your medical records may need to be shared with other doctors or healthcare providers. Sometimes, other providers help assess a patient's condition, screen for potential issues, or offer consultations. All healthcare providers are legally required to maintain patient confidentiality.

Information about your care may also be shared with healthcare agencies, your insurance company, or your self-insured employer. Aside from verifying insurance coverage, data released to third parties may include statistical information used for quality care and outcome measurements.

Please be advised that in accordance with applicable laws and regulations, we may be required to share details pertaining to certain reportable illnesses or conditions with public health authorities. This reporting is intended to ensure proper monitoring, prevention, and control of diseases that may pose risks to public health. Rest assured that any information provided will be handled securely and in compliance with privacy standards. If you have any questions or concerns regarding this process, please feel free to reach out to our office for further clarification.

Consent for Electronic Prescribing

I understand that Lyons Primary Care uses an electronic prescription system to send prescriptions and information between providers and pharmacies. My provider can see information about medications I'm Signaturealready taking, including those from other providers. I consent to this access.

3. SERVICE EXCLUSIONS

• No disability/accident/injury exams.

• No medical leave or paperwork visits.  

• No narcotic pain management visits.

3A. ADHD and Weight Loss Medication Exclusions

Florida - Stimulants and non-stimulant prescriptions are subject to provider discretion.
Other states - Due to varying state prescribing laws, stimulants are not available. Non-stimulant prescriptions are available and subject to the provider's discretion. 

3B. Anxiety Medication Exclusions

NO controlled/narcotic prescriptions.
Other medications types are available and subject to the provider's discretion.

3C. Pain Medication Exclusions

NO controlled/narcotic prescriptions. 
Other medications types are available and subject to the provider's discretion.

3D. Narcotic and Controlled Medication Policy

Lyons Primary Care Group will not prescribe narcotics or controlled substances unless deemed necessary by the provider, or for severe illness or injury occurring within 24-48 hours of service. If needed, a specialist appointment is recommended and should be scheduled by the patient. Requests for such prescriptions after agreeing to this policy will be denied. Repeated requests will lead to dismissal from the practice.

3E. Document Policy and Exclusions 

Lyons Primary Care Group does not process external documents, letters, or forms. We do not engage in letter-writing services. Providers at our group are under no obligation to generate, complete, sign, or approve any external document or request including medical leave, workplace accommodations, or other paperwork requests.

3F. Disability, Accidents, and Injuries

Lyons Primary Care Group focuses exclusively on comprehensive primary care and preventive health services. As such, we do not offer appointments for motor vehicle accidents, injury evaluations, or disability examinations.

3G. Appointment Wait Times - What to Expect
Visits with Lyons Primary Care Group are reserved in Central Standard Time (CST). Lyons Primary Care Group cannot guarantee exact visit times. Like an office visit, telehealth may involve a brief wait. Please allow a 65 minute window for your visit. If you're not contacted for your telehealth visit within that timeframe, call or text us at 205-774-0309. If your schedule is tight, we would be happy to help you reschedule for a more convenient time. Please note that refunds cannot be issued for extended wait times, as certain factors in healthcare are beyond our office's control.

Self-Payment

Payment must be made prior to receiving services. 

Insurance Payment

All applicable payments, including copays, deductibles, coinsurance, and other fees, must be made prior to receiving services. For questions about coverage or service costs, contact your insurance provider before your appointment. 

• What is a deductible? 

  • A deductible is the amount that you must pay for covered healthcare services before insurance will pay for services. 

• What happens if I haven't met my deductible?

  • If you haven't met your deductible, you'll pay the full cost of your healthcare service yourself. Once your deductible is met, your insurance usually covers part of the costs. Payment is required before services are rendered. 

• What is a copay?

  • A copay is the amount you pay for covered healthcare services once your deductible is met. Deductibles can vary in terms of amount and type. Payment is required before services are rendered.

• What is coinsurance?

  • Coinsurance is a percentage of a covered healthcare service that you pay after you've met your deductible. Payment is required before services are rendered. 

Lyons Primary Care Group will try to confirm benefits and secure payments before providing services, but coverage isn't guaranteed. It's your responsibility to understand your benefits by contacting your insurance company, reviewing your plan's summary, or checking the insurance website.

Authorization for Release of Information

I authorize the providers of Lyons Primary Care Group to furnish any medical information requested by insurance companies with whom I have coverage, any public agency which may be assisting in payment of my care or my employer who is providing payment of my medical bills due to injury on the job.

Assignment of Benefits

I request that payment of authorized insurance benefits (including Medicare) be made on my behalf directly to Lyons Primary Care Group for any medical services provided to me. I understand that I am responsible for any amount not covered by my health insurance. It is my responsibility to notify this office of any changes in my health care coverage.

Medicare

If my insurance is Medicare; I certify that the information given by me in applying for payment under Title XVIII of the Social Security Administration Act is correct. I certify that I am the patient or am duly authorized by the patient’s general agent to execute this document and accept its terms.

Payment Policy

I understand that I am obligated to pay the account of Lyons Primary Care Group in accordance with the regular rates and terms of Lyons Primary Care Group. Payments, including co-pays and fees, are due up front at the time of service. If I fail to make payment when due and the account becomes delinquent or is turned over to a collection agency or attorney, I agree to pay all collection agency fees, court costs and attorneys' fees.

I authorize for any overpayment to Lyons Primary Care Group Over to be applied directly to any outstanding balance for which I or my guarantor is legally responsible at the time of the collection of the overpayment. I consent for Lyons Primary Care Group to appeal on my behalf any insurance denial of payment for services provided to me.

Refund Policy

I understand that payment for an appointment with Lyons Primary Care Group includes a consultation with a health care provider and does not guarantee any specific diagnosis, treatment, or outcome. The clinician will evaluate my condition to determine what is appropriate. Inappropriate requests will be declined. All sales are final, and refunds are not available.

Account Balance

Patients must pay their account balance to $0 before receiving further services.

Cancellation

Lyons Primary Care Group needs a 24-hour notice for appointment cancellations. Failure to cancel in time may incur  cancellation or no-show fees not covered by insurance. Having three late cancellations or no-shows in six months could lead to dismissal from the practice.

Fee Schedule
Office or Telehealth Visit - Private Pay $100
Administrative fee, other $50

No show or same-day cancellation less than 24 hours before appointment  $50

Pre-operative clearance form $50

Blood sample (initial or routine testing), all visit types $40

Physical exam form (school, work, sports) $40

Urine sample, performed with office visit

No charge

Other lab specimen types (i.e.swabs)

No charge

I understand that although insurance may be billed as a courtesy, I am responsible for any charges not covered by insurance including fees outlined on our fee schedule. 

By signing, I acknowledge reviewing the Financial Policies of Lyons Primary Care Group, including Patient Responsibilities, Assignment of Benefits, Payment, Account Balance, Refund, and Cancellation Policies.