Address:30 E. Apple Street; Suite# 4256, Dayton, OH 45409 Call: +1-937-279-9777

Fax: +1-937-279-9332

Advanced Heart & Lung Surgeons

Mohey Saleh, M.D.

 

Please take time to read and be familiar with the following office and financial policies, as well as “About Your Bill,” appearing in the prior section of our web site.

New Patients: New Patients: You may complete your initial paperwork in our office (Very minimal), by utilizing the forms attached or by registering and using our patient portal. Please contact the office with any questions.

When you come to your first visit please bring with you: Driver’s license/photo ID, current insurance card(s), current medication list, copay amount and a referral, if needed. It is your responsibility to confirm with your insurance company if we are an in-network provider in your plan and if your plan requires you to have a referral to see a specialist.

Current Patients: Please make sure you notify the Receptionist of any changes in your insurance or demographic information (i.e. address/phone #). Please inform the Medical Assistant of any changes in your medications or medical history when you are taken to an exam room. You may be asked to fill out an updated medical history once a year. Please have with you at each visit your copay amount, payment for any outstanding balance and your current insurance card(s).

Appointment Cancellation: We request a 24 hour notice of cancellation of a scheduled appointment. Any appointment not canceled at least two hours prior to the appointment time will be considered a missed appointment.

Insurance Card: Please bring your insurance card to each visit. You are responsible for charges of any services rendered, including DME ordered, regardless of your insurance coverage.

If you are seeking a non-covered service, do not have insurance or if you are a participant in any insurance for which we are not a provider, please be prepared to pay fees at the time services are rendered.

Co-pays are due at the time of service – NO EXCEPTIONS. We accept cash, check, MC, Visa and Discover. If you do not have your copay amount at the time of service, you may be asked to reschedule.

Telephone Consumer Protection Act I authorize my healthcare provider and/or any entity authorized by this provider including those using automated dialing systems, automated messages, email, text messaging or other electronic communications to contact me for any reason by using any telephone number, email address and/or mailing address provided. I also give permission for Advanced Heart and Lung Surgeons and Dr. Mohey Saleh, M.D. to leave information regarding my healthcare on any voicemail or answering machine that I provide the number for.