Huy N. Trinh, MD Gastroenterology & Hepatology, Inc.

227 N. Jackson Ave Ste #235, San Jose, CA 95116 Phone: 408-430-1688

Fax: 408-430-1689

OFFICE POLICY

Our office is pleased to have the opportunity to serve you. Our primary mission is to provide you with quality, cost-effective medical care. Together, we (patients and your healthcare team) are trying to adapt to the changing ways that healthcare is financed and delivered.

The following guidelines were developed to help you through the process.

NO SHOW / LATE CANCELLATIONS:

In order to provide the most efficient scheduling to our patients, we need to keep appointment cancellations and “no show” activity to a minimum. In order to do this, we are implementing cancellation and “no-show” fees that will be charged to the patient if office

visits and/or procedures are cancelled without proper advance notice, or if the patient does not show up for a scheduled office visit and/or procedure. Thank you for your cooperation in helping us provide quick and efficient care to all of our patients.

Office Visit: 3 business days advance notice.

Failure to provide the required advance notice will result in a cancellation fee of $50.00. Procedure Visits: 7 days advance notice

Failure to provide the required advance notice will result in a cancellation fee of $200.00.

• You are responsible for this fee; it will not be billed to
• If you are 15 or more minutes late for your appointment, the appointment may be canceled and rescheduled.
• As a courtesy, we make reminder calls, for appointments, one to two days in

advance. Please note, if a reminder call or message is not received, the cancellation policy remains in effect.

• If you miss three or more visits consecutively, then, it is per our office policy to

discharge the patient from our practice, therefore, the patient is no longer able to schedule at our office.

APPOINTMENT REMINDERS

We have an automated email and text system that sends out appointment reminders 2-5 days prior to your visit. However, we do ask that patients/parents assume responsibility for their appointment time even if they do not receive an email reminder. It is also your responsibility to keep us updated on any changes to your email address and phone number so you can be sure to continue receiving reminders from our office. Please be advised, if

you opt in for an email/text message appointment reminder, you will not or no longer receive a phone call reminder in conjunction. There is no charge for this service, but standard text messaging rates from your carrier may apply.

SMS COMMUNICATION:

Huy N Trinh, MD Gastroenterology C Hepatology, Inc. utilizes SMS communication,

including SMS Chat and SMS Live, to enhance patient engagement and provide timely updates regarding appointments and care. Patients will receive SMS confirmations for scheduled appointments, along with reminders for follow-up visits and essential pre-

procedure instructions. Non-sensitive test results may also be shared via SMS, but detailed discussions should be directed to the office.

To protect your privacy, our SMS service is HIPAA compliant; however, we recommend that patients avoid sending sensitive health information via text. Patients can opt out of SMS communications at any time by replying with “STOP” to the SMS line at (408) 430-1688 or by contacting our office directly. We aim to provide clear and effective communication, and patients may receive multiple messages related to their care. Please note that the clinic is not responsible for delivery issues due to network problems or incorrect contact

information. SMS should not be used for urgent medical issues.

PATIENT PORTAL

A secure and convenient way to communicate with the office for non-urgent requests, questions, appointment requests, and updates of your medical history and general

information. If you are not currently set up on the Patient Portal, please visit www.huytrinhmdgi.com and click on Patient Portal to sign up.

TESTS AND RESULTS:

It is the patient’s responsibility to know what lab, radiology, and hospital facilities their

insurance will cover. If you are not certain, please call your insurance to verify with them.

Unfortunately, we are unable to know all the changes in insurance plans that exist. Your

benefits are negotiated between your Human Resource Department and insurance carrier; we do not have access to your contract.

Please keep your follow-up appointment. If your next appointment is within two-three weeks following your test we will inform you of the results at that time. Please allow 7-14 business days for results on labs, radiology, pathologies, and procedures. If you do not

have an appointment following your test, and you have not heard from us after 14 business days, please call us for results. You may expect to receive details on your results through the Patient Portal. If you are not set up on the Patient Portal, we will attempt to call you with results. If your results reveal a delicate status in your health, our Medical Provider will inform you promptly and appropriately.

PRESCRIPTION REQUEST AND REFILL:

Please contact the office during our business hours (9 AM- 5:00 PM on Mondays – Fridays) to request a prescription refill when you determine you are getting low on your medication.

Please do not wait until you are completely out of your medication to call. Allow 48-72

business hours for refills. Please call your pharmacy prior to pick-up to verify they received your script.

Prior Authorizations require approval from your insurance company and may take anywhere from 24 business hours up to 15 business days, depending on how long your

insurance takes to process requests. To speed the process, you may start your own Prior Authorization Request by calling your insurance company. If your insurance denies your

medication, you have the right to call them and make an appeal. Your pharmacy can let you know if your medication is approved or denied.

UPDATING YOUR INFORMATION

It is the patient’s responsibility to make sure we have your updated name, address, phone, email address, insurance, and pharmacy. It is our protocol to verify this information at each office visit. Please let us know if this information changes as soon as possible.

INSURANCE:

We accept most insurance policies at this time and will work together with you to ensure that your services are covered. We bill most insurance if proper information is provided. If there is a change in your insurance benefit you must notify our Front Office Staff

immediately. In the event that charges are denied due to problems with your insurance, we will do our part to have the problem corrected. If we are unable to settle the problem with the insurance company then the unpaid portion of the charge will be billed to you. It is,

however, the patients’ responsibility to contact the insurance carrier to verify his/her insurance is active and in network. Fee for returned check is $35 per incident.

Any portion of the charge your primary and secondary insurance does not pay within 30 days of billing will be billed to you. Since your agreement is with your insurance carrier and it is a private agreement, we do not routinely research why an insurance company has not paid or why it paid less than anticipated for the care services. Patient is responsible for all co-pays, co-insurance, and deductibles at the time of service. Any deposits which may be due for procedures must be paid at least 48 hours before the scheduled procedure.

Amounts not paid will be subject to cancelation of procedure or upcoming office visits.

Please be aware the physician’s service fee for performing the procedure(s) is separate from the Endoscopy fee charged by the facility/hospital for use of its endoscopy suite, supplies, and staff. Please note: Screening/Routine colonoscopies are not

Screening/Routine if any abnormality is found during the colonoscopy and will be filed to your insurance as a diagnostic colonoscopy. Your insurance may pay for endoscopic

procedures at Montpelier Surgery Center, Advanced Surgery Center, Regional Medical Center or O’Connor Hospital at the in-network or out-of-network rates. If you wish to find out an approximate fee allowed by your insurance company, please have the policy holder contact an insurance company representative. (Colonoscopy code 45378 and EGD code 43239 – these are subject to change upon findings during procedure.) It is possible your

insurance policy requires you to pay a deductible, co-insurance, or co-pay for this

procedure, which may be due prior to the procedure. If your deductible is not currently met, it is possible you may be asked to pay part of the deductible to the physician’s office prior

to the procedure and another part (if the deductible is still not met) to the facility/hospital. Your insurance will be billed for an official decision on payment.

Additional procedures/tests may be necessary once the primary procedure has begun.

These procedures/tests may include blood specimens or biopsies which will be sent to a third party agency for processing. These services are billed separately from the third party agencies. If Anesthesia is used, it will also be billed separately by the third party agency.

AFTER-HOURS / EMERGENCY:

In the event of an after-hour’s true emergency, go directly to the Emergency Room (ER.) If you call our office after-hours, our 24 hour answering service will promptly contact the physician who is on call if it is an emergency. Please use discretion when utilizing this

service. In an effort to provide you with the best care, all after hour cases of true emergency will be handled according to the problem. If you determine that you have an emergency during office hours, please do not wait until the evening to contact the office. Our medical staff will be made aware of your situation immediately and will attend to your problem

while they are in the office. If you have not heard back from us, at that moment, go straight to the ER. Never hesitate to go to the ER.

In the event that the physician is called out of the office due to a patient emergency, the staff will make every effort to contact you to reschedule your appointment. Please understand that due to emergency procedures and situations, there will be times that our Medical Provider may be running late to the office. Please be considerate in this situation, as we will provide the same delicate care for you or your family member as needed.

RESEARCH PROGRAMS:

Your physician may invite you to participate in a clinical trial or research program, which could be sponsored by a drug company or the practice itself. Participation is completely voluntary, and your consent will be obtained before joining any program deemed suitable for you. Your physician may receive compensation for their involvement in these programs.

REQUESTS FOR COMPLETION OF FORMS, QUESTIONNAIRES, AND MEDICAL RECORDS REQUESTS:

Due to a high volume of requests for forms/ questionnaires to be completed, letters to be created, and medical records requests, there is a fee for these services. Pre-payment is required for items A-C before we can provide the service for EACH request.

• For patients requesting their medical records, patient must come in to sign a Release Consent, and present First time records request will be no charge; subsequent requests will be $30. Turn-around: up to one month.
• FMLA forms, Disability forms, and other forms/questionnaires will only be

completed for gastro/hepatic-related disorders/diseases. There is a $30 fee. The patient is required to complete their portion on the forms/questionnaires. Forms will be completed according to the patient’s medical information and the physician’s professional opinion. Payment will not alter the physician’s professional opinion.

Completion turn-around-time: up to two weeks.

• For letters to be created by our Medical Provider, there is a $30 Completion turn-around-time: up to two weeks.

YOUR RIGHTS REGARDING MEDICAL INFORMATION:

Your medical records are the property of Huy N Trinh, MD Gastroenterology C Hepatology, Inc.; however, the information contained in the medical record belongs to you. By law, we are not allowed to give out medical information or test results to anyone, even relatives,

other than the patient, unless there is a signed consent form by the patient, patient’s Power of Attorney, or Legal Guardian. You may request a consent form from our staff. You may

also request a limit on the medical information we disclose about you to someone who is involved in your care or payment. You have the right to request a restriction or limitation on the medical information we use or disclose to another Medical Provider. We are not

required to agree to your request. There are no restrictions on disclosing information about you which may be used for treatment payment or health care operations.