Online patient forms
New patients and patients who need to update their information should fill out the online patient registration form. All patients should acknowledge that they have read our privacy and financial policies.
Insurance: We accept most forms of insurance, however, we are not on the panel for TennCare products. Our office is committed to providing quality and cost-effective healthcare to our patients. It is essential that you understand what services are covered by your insurance plan and obtain all authorizations prior to your appointment. Your doctor may recommend services he/she feels are beneficial but may not be covered by insurance. It is your responsibility to understand the limit and restrictions affecting coverage for these services. It is your responsibility to provide us with your most current billing information. Insurance reimbursement is a contract between you and your insurance company. As a courtesy to you we file all claims for you. We will require a current copy of your insurance card in order to do this and will need to be informed of all changes in insurance status. You will be responsible for all co-pays, deductibles, co-insurance amounts along with the entire amount of any non-covered services. Payment for services is expected at the time of service.
Self Pay Patients: We accept self-pay patients, who receive a 25 percent discount on their care. Patients who do not have insurance coverage (or proof of insurance) or who choose to pay for non-covered services are required to pay a $125 deposit at the time of service. The $125 is not the cost of the office visit but only a deposit. Office visits may range from $60-$189 depending on the office visit level. If any additional charges are incurred, they will be billed to the patient at a 25% discounted rate. If your office visit is determined to be less than $125 and no additional charges are incurred, we will issue a refund to the patient or guarantor listed on the account. Due to government regulations, it is considered fraudulent for us to accept payment from TennCare recipients for medical expenses.
Billing: We will send a statement (to the billing address you provide) notifying you of any balances you may owe. If you have any questions or dispute the validity of any balance, it is your responsibility to contact our billing office within thirty (30) days after the receipt of the initial statement. Patient balances not paid in full within (30) days of the statement issue date are deemed past due. Past due accounts may be subject to a $5.00 monthly late fee and may be referred to a professional collection agency and/or attorney for further collection activity. If you are not able to pay the balance due in full, you must contact our billing office to discuss a payment schedule. Any late fees already incurred on past due balances will be included in any mutually agreed upon arrangements. Under administrative guidelines, if your account has been sent to collections, Physicians Quality Care will not be able to provide services for you or your family until your account has been paid in full.
Your visit at the clinic
Please bring your government-issued photo ID and your insurance card with you when you come to the clinic. When you get here, we’ll need to see both and confirm your birth date.
Online Bill Pay
You can pay your bill online. Click here for our secure online bill pay.
You may need your medical records released from your provider to Physicians Quality Care or from us to another health provider. We have online PDFs of three options for releasing medical records.
Please download, sign and bring to the clinic the option that covers your needs.
Select a form to download:
Learn how we protect your privacy, click here.