Please click on the link below to be taken to a secure portal where you can input your medical history. Please fill this out before your visit.
You may also download our financial policy and our policy on autism appointments below:
3rd Opinion - 1415 First St S Suite 5 • Willmar, MN 56201 • 320 235 2101 • toll free 877 824 2101Office / Financial Policy Agreement
Office / Financial Policy Agreement
Thank you for choosing 3rd Opinion for your specialty medical care. We are committed to providing you with quality, personal health care, and appreciate your commitment to adhere to this Office/Financial Policy Agreement. Agreement with this policy is required for all medical care. Except as indicated below or arranged in ADVANCE, payment is required at the time services are provided. We accept cash, in-state personal checks, VISA and MasterCard credit cards. There is a $40.00 service charge for returned checks.
OFFICE HOURS are By Appointment Only.
As a courtesy to other patients, we request you arrive a minimum of 15 minutes ahead of your appointment. If you arrive more than 10 minutes late, you may be asked to reschedule. For emergencies, call 911 or go to the local emergency room. For non-emergent issues that CANNOT wait until regular office hours, please call our office. A message will guide you to the doctor on-call. There will be a charge for after hour calls. Please see below for office fees.
INSURANCE: We participate in most insurance plans and will bill your insurance plan as may be necessary. If we do not participate with your managed care plan, payment in full is required at the time of service, unless other arrangements have been made in advance. We may be able to bill your plan as a courtesy to you and credit your account if we receive any additional payment. Knowing your insurance benefits including eligibility, covered benefits and medically necessary procedures is YOUR responsibility; please contact customer services at your insurance company for questions you may have regarding your coverage. You are responsible for any charges not covered by your plan.
• Proof of Insurance. All patients must confirm and/or update their patient information including insurance as well as a photo (per insurance fraud rules and HIPAA) at each office visit. If you provide outdated insurance information, you will be responsible for the balance of the claim. Please notify us of any changes in insurance coverage prior to time of service. Insurance denials for termination of coverage will be automatically billed to you.
• Co-payments and deductibles. All co-payments must be paid at the time of service. By contractual law your insurance company requires us to charge for, and you to pay for, all required co-payments, coinsurances, deductible and non-covered services.
• Claim submission. We will submit your insurance claims and assist you in any way reasonable to help get your claim paid. Your insurance company may need you to supply information directly to them. It is your responsibility to comply with their request in a timely manner. The balance of your claim is your responsibility to pay and is due at your next visit with Dr. Sult or receipt of your bill, whichever comes first.
• Referrals. If your managed care plan requires approval or authorization for referrals to a specialist, radiological imaging, medical facility care, etc., it is your responsibility to inform our office of this requirement prior to referral. We require 3-working days (Monday-Thursday) notice to facilitate a referral request and cannot issue retroactive referrals.
OUT-OF-NETWORK CARE / SELF PAY: Please be aware that you have the option and right to seek care from physicians even though they are not participating in your network. In this situation, your out-of-pocket expense will be greater. As a courtesy to our out-of-network patients, we will file your insurance claim if desired, and offer a 20% reduction from our fees if paid on the day of service.
ADMINISTRATIVE SERVICES, CHARGES AND PATIENT RESPONSIBILITIES:
In order to be respectful of the medical needs of our community, please be courteous and call our office promptly if you are unable to attend an appointment. We require at least 3-working days (Monday-Thursday) notice, so that your appointment time can be reallocated to someone else. As a courtesy, our staff will try and call you the working day (Monday-Thursday) before your next appointment to help remind you to attend. However, this is a courtesy call only. It is your responsibility to remember your appointment. If you have any questions, please ask our receptionist.
• Missed Appointment. If a patient fails to call or show for his/her scheduled appointment twice, he/she will discharged from 3rd Opinion Co.
• Prescription refills. New prescriptions will not be issued without first seeing your physician. Prescriptions for acute care or chronic conditions are written with an appropriate number of refills to complete the course of treatment or to last until your next scheduled appointment. Therefore, refills should be accomplished at regularly scheduled appointments. This is to assess the effect and assure the best and safest medication care possible. All prescription requests are taken only during regular office hours and filled within 3-working days (Monday-Thursday). Controlled medications are not refilled over the phone at any time. Narcotic pain medications and stimulant medications/ADHD treatment medications will not be prescribed by Dr. Thomas Sult.
• Insurance Covered Medications. If a prescribed medication is not covered by insurance, it is the patient’s responsibility to contact their insurance company to ask what “alternative medications” are covered.
• Letters / Form completion. Letters and forms requiring medical review and physician signature are subject to a fee.
• Disability Paperwork Requests. Dr. Thomas Sult will complete disability paperwork requests only after he has seen the patient at least 4 times and he needs to feel completely familiar with the patient's entire medical condition before offering his opinion on disability.
• After hours calls. After hours calls for medical advice/treatment may be subject to a fee that is billed directly to you and is not covered by insurance. This is billed at a minimum time of 30 minutes.
• Requests for medical records. We require written requests including the patient or legal guardian’s signature for the release of medical records to assure your privacy.
Blue Cross Blue Shield Insureds. I understand that 3rd Opinion Co. and Dr. Thomas Sult is an out-of-network provider effective January 26, 2013, with Blue Cross Blue Shield of Minnesota. I understand I am personally financially responsible for my office visit(s), including any additional services Dr. Sult provides during my appointment. I also understand my office visit(s), including any additional services provided by Dr. Sult will be submitted to my insurance, Blue Cross Blue Shield of Minnesota (BCBS) and its affiliates by 3rd Opinion Co.’s billing department.