HILLTOP FAMILY PHYSICIANS

(phone) 303-841-2212 - (fax) 303-841-4716

Clark Benjamin Zimmerman, IV, MD     Linda M.Tetor, MD     Kent K. Horiuchi, MD
Michael J. Citrin, MD     Kettie D. Meyer, PA-C

Welcome To Our Practice!

Thank you for choosing us as your primary care provider. We are committed to providing you with quality and affordable health care. Below are our office and financial policies. Please read it, ask us any questions you may have, and sign it in the space provided. A copy will be provided to you upon request.

• Phones. Telephones are answered Monday through Friday from 7:30 a.m. to 5:00 p.m.
• Emergencies. Our practice has full-time coverage for patient emergencies that may occur after hours. If a problem arises during a time when the office is closed, simply call the office at 303-841-2212 and the answering service will contact the doctor on call. Your call will be returned in a timely manner. Please note that prescription refills and referrals are not considered emergencies and will not be done after hours.
• Prescriptions. All prescription refill requests should be called in to your pharmacy. Your pharmacy will then call the office if authorization is needed. Your refill requests will be handled by this practice within 48 hours after your pharmacy's request is received. Prescriptions will not be called in after hours or on weekends.
• Referrals. Referrals to other physicians or diagnostic facilities can take up to 72 hours for our office to process. Referrals will not be done after hours or on weekends. You are required to notify us at least 72 hours in advance of an appointment requiring a referral. Failure to do so may result in your referral being denied by your insurance company and therefore making you responsible for any and all charges incurred at the specialist's office.
• Test Results. Should you have any laboratory work or other diagnostic testing done through our practice, you will be notified of the results as soon as they are available (usually within 5 working days from the test date). All results must first be reviewed by the physician. You will then receive a call from the doctor's assistant or a card in the mail with the physician's instructions.
• Records Release. It takes our office 7 business days to process records requests. Records will be released to any physician upon your written request and authorization as a courtesy. There is a charge for personal records release requests. The usual fee is $14.00 for the first ten pages, $0.50 each additional page.
• Telephone Consultations. Our office charges for telephone consultations initiated by the patient or by the patient's guardian. Fees are updated in conjunction with the Center for Medicare and Medicaid Services fee schedule updates.
• Forms Completion. Our office charges $25 for the completion of forms. These charges will be your responsibility and will be billed directly to you.
• Insurance and Payment Policy
  • Proof of Insurance. We ask that you present your insurance card to us at every visit. If you fail to provide us with the correct insurance information at each visit, you may be responsible for payment for all services provided.
    • If your insurance company requires you to pick a Primary Care Physician (PCP), one of our physicians must be the PCP listed on your insurance card.
    • We are contracted with most insurance plans. If you are not insured by a plan we are contracted with, payment in full is expected at the time of service. If you are insured by a plan we are contracted with but don't have an up-to-date insurance card, payment in full for each visit is required until we can verify your coverage.
    • Your health insurance contract is between you and your insurance company. Knowing your insurance benefits is your responsibility. Any questions or complaints regarding your coverage should be directed to your insurance carrier.
  • Co-Payments. Your insurance company requires us to collect co-payments at the time of service. Waiver of co-payments may constitute fraud under state and federal law. Please help us in upholding the law by paying your co-payment at each visit.
  • Non-covered Services. Please be aware that some or all of the services you receive may be noncovered or not considered necessary by your insurer. You must pay for these services in full.
  • Claims Submission. We will submit your claims and assist you in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request.
  • Account Balances. All accounts with a balance due over 60 days will be assessed a monthly service charge of $25.
    • Partial payments will not be accepted unless otherwise negotiated with our billing office.
    • Unpaid balances over 90 days will be referred to a collection agency and you and your immediate family members may be discharged from this practice.
  • Missed Appointments. Our policy is to charge $35 for missed appointments not canceled within a reasonable amount of time. These charges will be your responsibility and billed directly to you. Please help us to serve you better by keeping your regularly scheduled appointment.

You will be required to sign a copy of this document at the office, stating that you have read and understood the office policies. (get PDF)