FAQ

Scheduling your visit is as easy as giving us a call! All we’ll ask is for basic information such as demographics, insurance, and if you have access to previous records. If you need to reschedule your appointment, you can call us back, and we'll be happy to arrange a better time for you.

Below is our financial agreement that you will be asked to sign at your new patient visit.

ASSIGNMENT OF INSURANCE BENEFITS AND FINANCIAL AGREEMENT

I hereby assign all medical benefits, to include major medical benefits to which I am entitled, private insurance, and any other health plans, to MD Total Care Michael Czarnecki, M.D. This assignment will remain in effect until revoked by me in writing. A photocopy of this assignment is to be considered as valid as the original. I understand I am financially responsible for all charges whether or not paid by my insurance carrier. I hereby authorize said assignee to release all information necessary to secure payment. I understand that I am responsible for the balance and remaining fees not paid by my insurance. I understand that if I do not pay my account in full, my account may be assigned to a collection agency for collection. I understand that if my account is assigned to a collection agency, the collection agency will charge a commission or fee that may be as much as 50% of the amount I owe. I agree that if my account is assigned to a collection agency, the amount of the commission or fees in addition to the amount I owe, and I agree to pay that amount. I understand and agree that in the event legal action is commenced to enforce my obligations hereunder, that I will pay court costs and reasonable attorney’s fees. I have read the above Assignment of Insurance Benefits and Financial Agreement and am accepting full financial responsibility for payment of professional services and any of my medical treatment.

Once you’re scheduled, we'll give you the essential preparation instructions. For all visits, new or established, please bring your ID card, insurance card, and list of current medications. If you have any pulmonary records from another facility, please bring them as well.

If you are scheduled for a pulmonary function test you will only be seeing the PFT tech, please save medical questions for the day of your follow up appointment. Preparation for your PFT is: 4 hours before no nicotine, caffeine, or inhalers AND 12 hours before no nebulizer medications.