Our intent is to provide the best possible care. As part of our care package we will provide: The most modern and advanced home medical equipment available A plan of care including follow-up visits, equipment checks, patient evaluation and assessment and a written evaluation sent to your physician Complete assignment billing to Medicare and all other insurance whenever possible. Around the clock emergency service 24 hours a day, 365 days a year In the event of foreign speaking clients and their families, we have several employees who are bilingual focusing on Spanish and Greek languages and will make every attempt to translate patient information and instructions. Also, we use IRSC at (772) 462-4722 to help in translating other languages.

In order to provide the best care possible, we need to work as a team. Communication is the foundation of teamwork and we need to hear from you, your family, or a neighbor when: You are admitted to the hospital You are informed by your physician of a change in therapy You have any concerns with our deliveries, staff or billing procedures You experience equipment problems You need additional supplies. If you let us know ahead of time we can assure you of prompt and timely deliveries. You have a change in insurance coverage. Doing so immediately will insure continuing payment of your bills by the insurance carrier and relieve you of any financial responsibility due to a lapse of coverage You can also assist us in providing you with the best care possible by observing the following: Reading all instruction sheets carefully Being available when we are scheduled to deliver supplies or equipment Learning proper care of the equipment. As always, we will be happy to review equipment care with you For ease in billing we ask that you provide us with all pertinent information whenever possible. This is especially important if the insurance pays you directly. Please send the explanation that comes with the check so that the funds are properly applied to your account Please keep in mind, we service many patients. There may be emergencies, which prevent us from being firmly on schedule. Your flexibility and understanding is recognized and appreciated.

After a patient has received the prescribed equipment and supplies, insurance information is compiled and verified. If a patient has two insurance companies, such as Medicare and a secondary coverage there may be a balance due after both insurance companies make payment. The dollar amount will vary depending on the type of equipment the patient has. In many instances the secondary insurance will cover the entire balance due. In the absence of secondary or supplemental insurance coverage there will usually be a balance due by the patient. You may contact a customer service representative to discuss payment arrangements if necessary. For patients with no insurance coverage financial arrangements will be made on an individual basis based on the patient’s economic status. If you experience difficulty paying your bill because of your financial situation, please contact our office. We can make alternative arrangements to accommodate you. Most importantly, we do not want you to feel reluctant to seek our services because you are having financial problems beyond your control. It is important that you continue to receive the medical care you need. Please call our office if you need to discuss this matter.

WE ARE HERE TO HELP YOU! Please call our office at (561) 750-6622 / (772) 335-1570 / (800) 827-2053 and ask to speak to a Patient care representative (PCR) who will be happy to listen to your concerns. The PCR will suggest the best solution to the problem and if necessary, will dispatch a technician to your home. If you have a complaint, please call our office and if you do not feel it has been resolved to your complete satisfaction you can call AHCA at (888) 419-3456 or the Attorney General’s office at 1-866-966-7226. If your issue is billing related the PCR might refer you to our billing department, who will be able to advise you. If your problem is equipment related and after hours, we have emergency service 24 hours per day. Our answering service can be reached at (561)750-6622, (772)335-1570, or (800)827-2053. If this is an emergency the answering service will forward the message to us to call you concerning your emergency within 30 minutes. Unless pre-arranged, or authorized by management, only emergency equipment deliveries (e.g. oxygen, nebulizers) shall be made after hours and on weekends and holidays. To report abuse, neglect, or exploitation please call toll-free 1-800-962-2873 REMEMBER . . . for all problems other than an emergency, please call our office anytime between 9:00 am and 5:30 pm, Monday through Friday. Again, those numbers are: (561) 750-6622 (772) 335-1570 (800) 827-2053.

Physician Choice Respiratory Services, Inc. (PCRS) recognizes that observance of a patient’s rights and responsibilities of self-determination through informed decision-making will contribute to more effective patient care and greater satisfaction for patients, their physician(s) and PCRS. We support these rights and responsibilities on behalf of patients. The following is a copy of these rights and responsibilities for your records. Access to Care: Individuals shall be accorded impartial access to treatment or services that are available, medically indicated and appropriate to the patient’s needs regardless of race, creed, sex, national origin or handicap Respect and Dignity: All patients have the right to considerate, respectful care at all times and under all circumstances, with recognition of their personal dignity. Privacy and Confidentiality: Patients have the right to privacy concerning their care. Patient records and communications are to be treated confidentially and are to be accessed on a “need to know” basis only. Personal Safety: The patient has the right to expect reasonable safety, in so far as Physician Choice’s equipment, practices and environment are concerned. Informed Decision Making: In order to participate in decisions involving their care, patients have the right to obtain complete information concerning diagnosis and treatment plans in terms that the patient can reasonably be expected to understand. When it is not medically advisable to give such information to the patient, the information should be made available to an appropriate individual on the patient’s behalf. Consent: The patient should not be subjected to any procedure without his/her voluntary, competent consent, or the consent of his/her legally authorized representative. The patient has a right to know, by name, the physician and other caregivers primarily responsible for coordinating his/her care. Communication: If a disability, language barrier, or other problem prevents effective communication with the patient, the organization should make every effort to provide an interpreter or other aid to facilitate communication. Refusal of Treatment: The patient may refuse treatment to the extent permitted by law and will be informed about the medical consequences of such a refusal. Continuity of Care: The patient has the right to expect that services needed and ordered by the physician and required by his/her condition will be available and provided in a timely manner. If referral to alternative services or another organization is required, the patient should be informed of this as soon as possible, including any financial benefit to the referring agency. The patient has the right to information, which will assist in recovery after discharge from the organization. Charges: The patient is informed upon acceptance by PCRS, of the charges and policies concerning payment for services, including insurance coverage and other sources of payment. The patient has a right to request and receive an itemized and detailed explanation of the total bill for services rendered by Physicians Choice regardless of the source of payment for that care. Resolution of Patient Complaints: The patient has a right to voice concerns and discuss problems about their care without discrimination, reprisal, or unreasonable interruption of services. Upon admission, the patient should be informed whom to contact to resolve such problems. In addition, the patient has the right to voice grievances and suggest change in service or staff without fear of restraint or discrimination. In the event of such a problem, please call our office and ask to speak directly with our Office Manager, Maria Mamangakis. In addition you can voice your complaint with AHCA(Agency for Health Care Administrations) at 1-888-419-3456. Referral: A patient denied services solely on his/her inability to pay shall have the right of referral.

Provision of Information: A patient has the responsibility to provide, to the best of his/her knowledge, accurate and complete information about matters relating to his/her health. A patient has the responsibility to report unexpected changes in his/her condition to the responsible practitioner. A patient is responsible for making it known whether he clearly understands the plan of care/service and what is expected of him/her. Compliance with Instructions: A patient is responsible for following the treatment plan recommended by the practitioner primarily responsible for his/her care. Refusal of Treatment: A patient is responsible for his/her action if he/she refuses treatment or does not follow the practitioner’s instructions. Organization Charges: A patient is responsible for assuring that the financial obligations of his/her health care are fulfilled as promptly as possible. Organization Rules and Regulations: A patient is responsible for following rules and regulations affecting patient care and conduct. Respect and Consideration: A patient has the responsibility to respect the rights and the professional integrity of those providing care. The patient is responsible for being respectful of the property of other persons and of the organization.

All information concerning the patient is of a confidential nature and must not be discussed with persons not involved in the care, unless written authorization is obtained. Case discussion, consultations and care are confidential and will be conducted discreetly. Persons not directly involved in the care of the patient must have the patient’s permission to be present while care is given. Only those persons authorized by the patient, the physician in charge, designated therapist and PCRS staff directly responsible for patient inquiries (billing, deliveries) have access to patient files Inquiries and/or investigations concerning patients will be directed to the appropriate source of information. All patient information is kept in secure, electronic files.

PCRS will maintain and service its rental equipment without charge; however, there may be extenuating circumstances for non-emergency calls where an additional charge may apply. Some equipment is rented at rates available from our business office. Rental charges will continue to accrue until equipment is returned to PCRS. No credit or refund is given for any unused portion of a rental period. All rental charges, transportation charges on shipments to and receipts from out-of-town customers, service charges and any other charge to be paid by customer are due and payable at the office of PCRS. If payments are not made in accordance with these terms and conditions, PCRS may take possession of such equipment without notice. Customer agrees to indemnify PCRS against all loss, liability and expense from claims of injury to person or property (including death claims) resulting from customer’s use of equipment and products of PCRS. Customer will not move rented or leased equipment from the address at which it is delivered without the written permission of PCRS. By giving written notice to PCRS a customer may elect to purchase rental equipment at PCRS’s published prices. All rented equipment and cylinders delivered to or received by customers remain the property of PCRS. In case of loss or damage the customer agrees to pay PCRS the replacement value of the equipment rented herein.

PCRS is a home medical equipment company specializing in oxygen, respiratory and sleep therapies. The following is a list of the most frequently dispensed equipment. Oxygen concentrators Compressed oxygen cylinders Portable oxygen systems w/conservers Medication compressors (nebulizers) Respiratory assist devices (BiPAP) CPAP units and supplies Nebulizer Medications Wheelchairs Ambulatory aids Other home medical equipment may be available or may be able to be special ordered for you. Please ask a staff member about any equipment not listed above. In most cases, equipment we provide is dispensed on a rent to own basis. This equipment will be paid by insurance until the designated purchase price. The patient will be responsible for their portion until the purchase price is met. PCRS follows all manufacture warranty guidelines. PCRS is a Florida licensed and Medicare approved provider. Our staff will bill your insurance companies directly, primary and/or secondary. We do not provide home health care services, i.e.; nursing care or homemaker aids. Our task is to provide and dispense home medical equipment, provide proper instruction for its use and maintain equipment in accordance with manufacturer’s standards.

The following information is provided as a basic guideline to insurance coverage and payment expectations for home medical equipment. MEDICARE – Medicare generally pays 80% of the allowed amount, after any deductible, for the following equipment when the criteria for medical necessity are met and with the properly completed paperwork from your physician. Oxygen CPAP Ambulatory aids Nebulizers BiPAP Wheelchairs Nebulizer Medications Whenever possible PCRS will accept assignment on Medicare claims. This means that we will accept Medicare’s allowable amount as payment in full. Since Medicare reimburses at 80% there is a 20% co-pay which we will gladly bill a secondary or supplemental insurance for you. If you have no secondary/supplemental insurance the 20% balance will be billed to you. Medicare does not pay for any bathroom aids, such as grab bars, raised toilet seats and shower benches. COMMERCIAL INSURANCE – Commercial insurance carriers coverage varies greatly based on each individual policy. In most cases, if there is coverage for the doctor’s office visits, home medical equipment is also covered. Most often plans pay a percentage of the charge, such as 80%, leaving a co-pay balance, which will be billed, to the customer. It is recommended that you contact your insurance carrier to determine their specific coverage guidelines and any special medical documentation required. We always submit a doctor’s prescription showing medical necessity with the claim. EACH PERSON’S SITUATION MAY BE UNIQUE WHEN IT COMES TO COVERGE OF HOME MEDICAL EQUIPMENT, THEREFORE, WE ENCOURAGE YOU TO CALL OUR OFFICE IF YOU HAVE ANY QUESTIONS ON YOUR PARTICULAR CASE. IT MAY REQUIRE SOME RESEARCH ON OUR BILLING STAFF’S PART. WE MAY ALSO NEED TO OBTAIN AS MANY SPECIFICS AS POSSIBLE FROM YOU, SO THAT WE ARE ABLE TO GIVE YOU THE MOST ACCURATE INFORMATION AVAILABLE. WE APPRECIATE YOUR PATIENCE IN ADVANCE.