News & Announcements

Feb 18

Welcome to our medical office! We are dedicated to providing you with the best possible healthcare experience. To ensure a smooth and efficient process for all our patients, we have established office policies. These policies will help us maintain a high standard of care, ensuring your safety and comfort during your visit. We kindly ask that you take a moment to familiarize yourself with these policies to help us create a positive and effective healthcare environment. You are encouraged to utilize the provided links to thoroughly review each policy.

1. Understand the check in process here

2. Complete the online pre-registration and patient forms here

3. Learn Best practices for communicating with the office and medical team here

4. Read the General Office Policies here

5. Learn the Annual Physical Exam and Well Woman Exam Policies here

6. Learn how to complete your virtual visit here

7. Learn how to set up your language services if English is not your first language here

8. Read our Medical appointment Etiquette here

9. Learn How to navigate the patient portal review your lab results, imaging reports, medical records and more, here

10. Understand the specialist referral policy and process here

11. Review the insurance referral processing timeline estimates here

12. Understand the medication prior authorization policy and process here

13. Learn how to leave a positive review or comment, here

14. Learn how to file a complaint with the intention of resolution here

15. Learn how to request your medical records here

Feb 18

Please be aware of the following requirements before your medical visit. We have simplified the checklist for you here.

• Complete the Pre-Registration forms electronically or print and complete them prior to your visit. Please be aware that there may be additional paperwork or forms to complete during the check-in process.

 

• Please present your VALID government issued ID

 

• Please present hard copy insurance cards or printouts at the front desk when you arrive. We cannot accept images or digital cards.

 

• Please be prepared to remit outstanding balances, copays, deductibles, and coinsurances at the time of check-in. You will not be able to check-in for your scheduled appointment if you do not remit your patient responsibility. 

 

• Bring a list of all of your medications, supplements, and vitamins

 

• Bring any pertinent medical records from specialists, previous PCP’s, and test results. It is your responsibility to request your medical records. This will help us provide you with the best possible care.

 

• If you require blood draw during your visit, we kindly request that you schedule your  appointment no later than 2:00 PM CST. This allows us enough time to collect the necessary samples and process them within our laboratory’s operating hours.

 

• Please make sure that you learn how to conduct a virtual visit before your virtual appointment. The process and instructions are outlined on our website. If you are not prepared or checked in at the time of your visit or by the time the physician is ready to see you, we will have to reschedule. Review the Virtual Visit process here.

 

• Be prepared for possible delays. We understand that patient appointment times may vary, and there may be occasional delays. We strive to minimize these delays as much as possible and appreciate your patience in such situations. Review our Medical Visit Etiquette here. 

Feb 18

We recognize that gearing up for a medical visit can often be a source of anxiety and may feel hurried. To alleviate this, we’ve designed a check-in process aimed at providing you with peace of mind and facilitating your smooth transition from being a prospective patient to an established one swiftly. By adhering to these straightforward steps and utilizing our comprehensive checklist, you’ll find yourself well-prepared and ready for your upcoming medical visit.

1. Read and understand your health insurance policy.

It’s crucial to familiarize yourself with your insurance plan prior to any visits. Be aware of your personal financial responsibility for each visit to ensure a smooth check-in process. Also, it’s important to comprehend the number of preventive visits and sick visits you’re entitled to annually. Ignorance in this regard could lead to unforeseen complications or financial burdens.

It’s of utmost importance to thoroughly comprehend your co-pay, deductible, coinsurance, and outstanding balances. It’s crucial to meticulously read the details provided by your insurance company. This will help you discern what is covered and what isn’t, thereby preventing any unforeseen financial surprises or burdens.

Be cautious: If a service is excluded from your plan, you must pay 100% of the cost. Ensure you opt for covered services to avoid unexpected expenses.

2. Please complete the patient forms prior to your visit.

There are multiple patient forms that must be filled out before your appointment. If you choose to complete these forms online, a link will be sent to you via email and text message 7 days, 72 hours, and 24 hours before your visit. This link can be used to fill out the necessary forms at your convenience. It is crucial to ensure that we have your preferred mobile number and email address accurately recorded. This will prevent you from missing out on the all-important pre-registration notification.

If you prefer paper forms, print them yourself here. We won’t do it for you. Access and complete the forms via the patient portal here. These forms include the Authorization for Release of Medical Information, the Authorization and Consent for Treatment, the Preferred Contacts Form. The Health History Form can only be found in the patient portal.

Failure to complete forms will result in rescheduling. Completing the forms takes 20-30 minutes. Partially completed forms also lead to appointment delays and will require rescheduling. Compliance is crucial; no exceptions can be made by the team.

3. Please bring the items needed for check-in

Firstly, please ensure you bring a VALID government-issued ID. You will not be able to complete check-in if your ID is expired, does not have a photo, or is not issued by a government entity.

Secondly, please bring your insurance card. This is very important; you must present your physical insurance card at every visit. We cannot accept an image from your phone, even if you completed pre-registration and scanned a picture of your insurance card. When you show up to the office, you need to have a physical version to hand to the team member checking you in.

This can be a physical card or a printed version of the card issued by your insurance company. It must be a physical copy; we cannot accept images. If your insurance company has transitioned to digital cards only, you will need to print the card before coming to the office. Our team members will not print cards for you, and you cannot email the card to them.

Lastly, we need your payment information to keep on file for each visit. If you have a deductible, copay, or outstanding balance, please present your payment card. Our payment software is encrypted, ensuring the security of your data while it is stored temporarily. We update the credit card on file at every appointment if you have to make a payment. If you want to read the policies on how the credit card on file works, please click the link below.

You need to understand the importance of the required items for the check-in process. These items are non-negotiable. If you arrive for your visit without them, we will unfortunately have to reschedule. My team members cannot make any exceptions to this policy.

Feb 18

Your well-being is our ultimate mission! We urge you to carefully read and follow the steps we have outlined below. This will ensure a phenomenal experience as we cater to all your healthcare needs with the utmost dedication and precision!

Appointments and No Shows

1. We have an appointment only based clinic system. Any questions or concerns outside of a scheduled office visit, need to be addressed through Klara text at (832) 979-1792. We do not answer questions for walk-ins. 

2. We enforce a strict no show policy. Failure to appear for your visit or cancel 24 hrs prior, will result in a $25 no show fee. Failure to pay the fee will prevent you from rescheduling. Patients covered under a Medicaid plan will not be able to reschedule for 30 days after a no show. After 3 consecutive no shows or rescheduled appointments, you will be released from our care and will need to find a new PCP.

3. We do not have a walk-in lab. You must schedule your lab appointment. All labs must be authorized by Dr. Giles prior to your scheduled lab appointment.

Insurance and Billing Disputes

1. Some insurance plans require physician assignment. Please make sure to assign Dr. Giles as your PCP prior to your visit. Please provide us with the reference number, the name of the insurance representative, and the date of your call for your file. Failure to do so, will result in a rescheduled appointment or self-pay visit.

2. We have a process for questions regarding balances and payment responsibility. Please text (832) 979-1792 to request a billing dispute form. Once your completed form is received, we will respond to you within 7-10 business days. This will give us time to research and to determine financial responsibility. The response will be final. If you still have a question after the dispute,  you will need to contact your insurance company for further clarification.

3. Please click here to download the Official Billing Dispute Form.

Clinical Policies

1. Medical Assistant interactions are limited. The Medical Assistant is responsible for checking vitals and gathering preliminary information on behalf of the physician. Please direct any medical questions to the physician during your visit.

2. Visit times are limited to 15-20 minutes. We respectfully request that you limit your questions or concerns to 1-2 problems. Prioritize your list to discuss the most important issues first. Then you can schedule a follow up appointment for additional problems.

3. Prescription refills require a doctor visit (virtual or office). We will not be able to refill prescriptions in between appointments. Please have all of your prescriptions refilled at your appointment to avoid delays.

4. Lab results are automatically posted to the patient portal. Discussion with the physician requires an appointment. Imaging results can be posted to the patient portal per your request, however discussion and next steps will require an appointment.

5. Physical therapy authorizations – Physician signatures for physical therapy authorizations and recertification orders will require a medical appointment every 30-60 days.

6. Home Health Authorizations – Physician signatures for home health will be completed every 60 days. If you need continuation or re-certification of your Home Health services, you will need to make a virtual or office appointment.

Controlled Substances

We do not prescribe opiates, benzodiazepines, stimulants or other controlled substances for long term/chronic conditions. If you request or require these types of medications, you will be referred to the appropriate specialist for evaluation and management.

Office Conduct

1. We want to maintain a respectful work and medical environment. Please do not use profanity in the waiting room, tease or bully the medical team or other patients.

2. Patient privacy is crucial. Please refrain from talking on the phone, taking photos, videos or audio recordings in the waiting room or patient rooms.

File a complaint 

We understand that you have the freedom to put a negative review on Google and to file a formal complaint with the Texas Medical Board. However, we are asking that you try to resolve any errors or communication issues with our office first. We do not want to take any steps that lead to dissolving our physician-patient relationship.

To file a complaint with our office first, please access and download the form here. Thank you.

Feb 18

We appreciate your cooperation!

Feb 18

Preventive Exams are also referred to as Annual Physical Exams, General Wellness Exams, Pediatric Well Child Check Ups, Pap Smear Exams, and Well Woman Exams. Please read below to find out which types of concerns are completed or excluded during a preventive exam.

Preventive exams include the following services.

• General questions about your medical, family, surgical, and social histories

• General orders including:

  • Complete blood count

  • High cholesterol screening

  • Diabetes screening

  • Thyroid disorder screening

  • Complete metabolic panel

  • Pap smear swab tests

  • STD/STI testing

  • Orders pertaining to colon cancer screening

  • Prostate cancer screening

  • Lung cancer screening (if you qualify)

  • Breast cancer screening

  • Abdominal Aortic Aneurysm screening (if you qualify)

  • Other preventive screening tests for your age and birth gender

Preventive services and orders are only provided if you do not have a medical complaint or problem. We cannot bill any medical diagnoses as a preventive exam.

Well Woman exams are only provided if you have completed a general or annual physical exam within the prior 12 months. New patients need to bring the records from their previous Annual physical exam.

Preventive Exams do not include the following services.

• Additional labs for vitamin deficiencies or any type of anemia

• Auto-immune testing

• Vaginal health complaints

• Pregnancy tests

• Medical complaints

• Non-physical exam related forms

• Medication refills

• Imaging orders for non-screening purposes

If you are registered to receive a preventive exam, but want to have a problem evaluated, you will need to change the reason for visit at the time of check-in. You will be responsible for your copay, coinsurance, deductible, and any other patient responsibility assigned by your insurance company.

If you do not follow these steps and inform the Medical Assistant that you are changing your reason for visit, you will be required to go back to check-in or reschedule your appointment.

Feb 18

We have created several ways for you to communicate with us, and while we have our preferences, we understand that you have your own. Please make sure you understand how your preference works.

1. We’d love to text you.

Text messaging is our preferred way of communication. Messages come in rapidly, and we have someone checking them throughout the day to provide a quick response. If you are texting Dr. Giles, please allow 24 to 48 hours for a response as I need to attend to all messages while managing patient care, closing charts, and handling other business responsibilities. Rest assured, your text will be routed to me, and I will respond to them in the order they are received. Thank you for your understanding.

The text number is 832-979-1792. You can text us back just as if you were texting your friend. You can text directly in the chat or click the link provided to send a message. Due to HIPAA regulations, we cannot text back like your friend, so you will always receive a link for our response.

2. If you prefer phone calls

Traditional phone calls have limited availability as we receive numerous calls every day. If you call, you may have to wait on hold or be sent to voicemail if the lines are busy. Rest assured that your voicemails are stored in Klara within your file, and we can access and play them from there. A team member will return your call within 24 to 48 hours. If you call us and do not leave a voicemail, you will not receive a call back. We do not simply return calls based on the call history; to receive a call back, you must leave a voicemail.

If we do not respond to you within 24 to 48 hours, there may have been a delay, so please allow us 72 hours. We are working hard to assist many people, and if your concern is left on voicemail, it indicates that it is not urgent. At times, urgent and emergent issues may take priority as we are a medical office. If we are unable to answer your call, please refrain from calling repeatedly. Doing so will tie up the phone lines even further.

3. Sending and receiving messages in the patient portal

Lastly, the patient portal is currently the slowest method to message us. I check the portal once a week, every 7 days. Therefore, it is essential to use the portal for uploading, viewing, and downloading records, or simply for providing any necessary information for your records. Please do not use the portal for billing questions or urgent matters. Instead, use the messaging feature on the website. You can access this by clicking on the messages button in the lower right corner of the website. Simply input your name and date of birth, and you will be able to send us a message directly.

Feb 18

Thank you for completing your visit with Thrive Family Clinic! We are excited to be your partner in health. Here is a list of items you may need to stay on top of your care until your next visit.

Please review the After Care Checklist.

1. Your medication and imaging orders will be signed by the end of the business day, be sure to review your visit care summary within 7 business days.

2. Check your patient portal for lab results within 5 business days,

3. If you have requested a referral, prior authorization, or surgical clearance please allow up to 30 business days for the completion of the process. Regularly check your patient portal or keep an eye out for text updates regarding the status of your referral. You can review the referral process here.

4. If you have received a 30, 60, or 90-day supply of medications, please remember that you will need a follow-up visit for refills. It is important to schedule this visit ahead of time to ensure a seamless continuation of your medication regimen.

5. If you have any questions regarding your refill, please contact your pharmacy first.

6. If you have physical therapy, medical equipment order, or home health authorizations, please note that follow-up appointments are required every 4 – 8 weeks. It is crucial to adhere to this schedule to avoid any delays in obtaining necessary signatures.

7. For your convenience, the best way to reach us is through text at (832) 979-1792. We believe that text messages provide a quick and efficient means of communication, allowing us to respond to your inquiries promptly.

8. Appointments are required for discussing lab results, speaking with Dr. Giles, and completing administrative requests. Read more about the administrative process here.

9. Lastly, if you were satisfied with your care, please complete our post visit survey and leave a Google review here to let us know what we did well. Please also leave an additional review for Dr. Mercedes Giles, MD, here. However, if you were not satisfied with your care, please respond to this message to let us know about the issue and we will address it promptly. You can also use our Official Complaint Form here.

Thank you for choosing Thrive Family Clinic!

Feb 18

We recognize that managing administrative tasks or paperwork can be challenging, especially when undergoing medical treatment. We are committed to assisting you in easing this process while adhering to necessary guidelines. These guidelines ensure that all forms are accurately and promptly completed.

However, please note that there are certain forms we cannot complete due to specific exclusions. Also, be aware that form completion may incur fees as your insurance might not cover this service. Please continue reading for a detailed understanding of our administrative process.

Tasks completed by you (the patient)

• Insurance communication beyond basic eligibility and verification

• General medical records requests by the patient or by other clinics, hospitals, etc –

  • Printed: $25 for the first 20 pages, then $0.50 for every page after

  • Electronic: $25 for 500 pages or less and $50 for more than 500 pages

  • Imaging studies – $8 per copy of an imaging study.

• Execution of an affidavit – $15 may be charged for executing an affidavit

Tasks that only require a medical visit without additional fees

• Request to appeal or renew specialist referral authorizations and prior authorizations for non-formulary meds

• Physician letters for work excuses and release back to work for a condition treated in our office

• Medical Procedure Pre-Surgical Evaluation – Requires an office visit. Only completed for patients established for 12 months or more

Tasks that require a Medical Office Visit and additional fees

• FMLA forms $75- specifically pertaining to the problem addressed in the PCP visit, excludes specialist’s diagnoses. Physician pre-approval must be requested.

• Medical Accommodation forms $75 – completed for work or school, excludes specialist’s diagnoses. Physician pre-approval must be requested.

• Physician letters $75 – Specific requests for letters. Excludes work excuses and release back to work. Physician pre-approval must be requested.

• DMV Handicap Placard Forms – $25 plus the additional notary fee

• Life Insurance Exam and Medical Records – the third party requesting the records covers the cost. We will follow the guidelines outlined by the TMB for calculating the cost of furnishing your medical records.

• Medical Records Requested by Legal Entity/Lawyer – the third party requesting the records covers the cost. We will follow the guidelines outlined by the TMB for calculating the cost of furnishing your medical records.

• Sports Physical Exams with form completed within 5-7 business days. $70

• General school/work Physical Exam forms completed within 5-7 business days – $25 with a preventive exam

• Insurance exception requests for an out-of-network facility referral or treatment. Additional fees may apply. $150

• Expedited forms & form revision requests – add $25 to any of the fees listed

Tasks that are not completed by our office

• Elective Cosmetic Procedure Pre-Surgical Evaluation

• COVID Vaccination Exemption forms or letters

• Emotional or medical pet forms or letters

• Evaluation for disability or injury for work, legal, or disability benefits

Disclaimer: We do not charge a fee for a medical or mental health record if the request is related to a benefits or assistance claim based on the patient’s established disability.

Feb 18

Your insurance plan may require an approved authorization for you to visit a specialist. As your Primary Care team, we are happy to assist you with your specialist referral request. First, you will need to schedule a medical visit for the initial authorization request. Here are the steps you need to take:

Gather the specialist’s information

• Search your insurance member portal or call a customer service agent to identify specialists located near you.

• Contact your chosen specialist’s office to confirm that they are accepting new patients with your plan and that they have availability within your time frame.

• Document the following information:

  • Specialist First and Last Name (we need the exact name of the specialist you want to see)

  • Specialty Type

  • Specialist Office Address (that you prefer)

  • Specialist Office Phone Number

  • Specialist Fax Number

The insurance review process and waiting period

Please note that the authorization confirmation from your insurance company may take up to 30 business days. Insurance processing times may vary, for more detailed information, read here. If you do not select your specialist and submit the required documentation, your referral request will be placed on hold until we receive that information.

Repeating or Renewing your referral

If you need us to repeat the referral due to out-of-network, authorization expiration, requirement for follow up or other reasons, you will be required to set an appointment for a follow up visit. The repeat referral will follow the same process as outlined above.

Access your specialist referral information from the patient portal

Once your referral is approved, you will receive an approval notification via Klara text or the Athena patient portal. Then, you will be able to access the full order and dates of eligibility in the patient portal. Please follow the steps outlined here.

You must use a DESKTOP or LAPTOP to perform this task

• Log in to the patient portal

• View the Left hand menu

  • Click “My Health”, then click “Health reminders” in top menu bar, then click the specialist’s referral order needed, then click “Print” to print or save to your device.

• You will be able to see all of the info pertaining to the referral and the associated progress note. You can print the documents as well. This step is recommended as it will help you have all of the necessary info needed on your appointment day with your specialist.

• Finally, you can call the specialist’s clinic to schedule your appointment and to give them the authorization number over the phone.

Rest assured, you can request updates on the progress of your referral request through via text message at (832) 979-1792.

Feb 18

Your insurance plan may require a referral authorization for you to see a specialist.  Before you schedule the appointment, you need to be aware of the outlined steps for processing times. Our office typically takes about 24-48 hours to process your referral requests before submitting the order to the insurance company.

Once the insurance company receives the order, processing times vary depending on the network and plan. Keep reading to learn more about the specific process for your network and plan.

• Aetna Network and Plans typically have a processing time of 2 to 3 business days and are eligible for one year per diagnosis.

• For BCBS HMO, the processing time is within two to three business days, and it is eligible for up to six months per diagnosis.

• For BCBS POS, the processing time is 2 to 3 business days, and it is eligible for 3 months per diagnosis.

• Cigna, including HMO, POS, Healthspring, and Medicare insurances, takes seven business days to process our request. Once approved, it is eligible for one year per diagnosis.

• Humana Commercial or Medicare PPO does not require authorization.

• For Humana Commercial or Medicare HMO, the processing time is 2 to 3 business days, and it is eligible for up to 6 months per diagnosis.

• For Ambetter HMO plans, the authorization requirements vary depending on the plan. The processing time is typically 2 to 3 business days once submitted through the Ambetter portal, and it is eligible for up to 6 months per diagnosis.

• For the United Healthcare commercial, Medicaid, Medicare, and WellMed plans, no authorizations are required to see specialists.

• For the United Healthcare marketplace plan (TXONEX), an authorization for referrals is required.

• WellCare, an HMO Medicare Advantage plan, takes 14 calendar days to process requests. Once submitted, they review the request for up to 7 days, totaling a processing time of 21 days. The authorization is valid for 2 months per diagnosis and covers up to 10 visits.

Please be aware that if you require a referral for an additional or new diagnosis or your eligibility for the referral has expired, you will require a medical office visit for evaluation and to start a new request.

Feb 18

Prior authorizations (PA) for medications are usually required for high cost, brand only or specialty medications. Your insurance plan determines whether a prior authorization request is required.

We are no longer processing prior authorization requests for medications after January 2024. If you receive a notification from the pharmacy that a PA is required, you will need to schedule a follow up medical visit to choose an alternative medication or for a referral to a specialist who will determine if the specialty medication is the right option for you.

For all patients who received medications requiring prior authorizations prior to January 2024 you will need to complete the following steps.

1. If your request has been approved, you need to fill the medication as recommended by Dr. Giles. If your PA has an end date, then you will need to follow up for a specialist referral when the current PA has expired.
2. If your request has been denied, you will need to call your insurance plan to obtain a list of alternative options. Then, make a follow up appointment so that Dr. Giles can determine a suitable alternative that is covered by your plan.

Thank you for your cooperation.

Mar 1

Insurance lingo got you feeling confused and overwhelmed?

We hear you – insurance can be pretty complicated to understand, and you may avoid seeking needed care because you fear surprise costs. However, mastering a basic understanding of your insurance plan and the associated terminology can help you feel more confident and empowered when seeking care. We’ve compiled a short guide to walk you through the basics. 

Health Insurance Terms to Master

Copay: The copay is a fee you pay each time you visit a doctor or specialist before your insurance kicks in and covers the remaining costs of the service performed on that visit. This fee is paid to your doctor’s office. 

Deductible: This is the amount you must pay out of pocket per year before your insurance will kick in and begins to cover the costs of medical services billed throughout that plan year.  

Coinsurance: Once you have met your deductible, you may be required to pay coinsurance on some services that aren’t 100% covered by your insurance. So, for example, a 20% coinsurance means you will need to pay 20% of the service, while insurance will cover the remaining 80%. This cost is additional to your copay.

Premium: The premium is the monthly fee you pay for insurance coverage. This may be automatically deducted from your employer-issued paychecks, or you may pay for it yourself through the insurance marketplace. The premium payment goes directly to the insurance company and does not automatically cover the cost of any medical services provided by your doctor. 

Out-of-pocket maximum: This is the maximum you have to pay for covered services in a year. After you’ve spent this amount on copayments, deductibles and coinsurance for in-network care, your insurance plan pays 100% of the costs for covered benefits after that. The out-of-pocket maximum doesn’t include monthly premiums, out-of-network care, any services not covered by your plan, and charges above the allowed amount for a service billed by a provider. 

What is the difference between HMO and PPO insurance?

The two most common types of health insurance are HMO (health maintenance organization) and PPO (preferred provider organization).

HMOs

These plans have a lower premium than PPOs and give you access to a network of doctors with which the insurance company has set price agreements. However, HMO plans typically don’t cover out-of-network providers, and specialist visits must be coordinated through your primary care physician. 

PPOs

While these plans have a higher premium, they allow more flexibility allowing you to see specialists without a referral from your PCP and the option to seek care from out-of-network providers. However, your out-of-pocket costs, such as copay and coinsurance, will be lower if you see an in-network provider. The advantage of using in-network is that those providers will have preset rates established for their services through the PPO. On the other hand, your coverage with out-of-network providers may be much more limited, and your out-of-pocket costs will likely be higher. 

With both types of plans, you’ll still usually have a monthly premium and both may require you to meet a deductible before services are covered. 

Pro-tip to avoid surprise costs

When looking for a new healthcare provider, it’s always a good idea to call your insurance and confirm if the doctor is in-network or out-of-network before booking an appointment. 

 

Written for Thrive Family Clinic, LLC | Copyright 2023. All rights reserved.