For Patients and Families - Wright State Physicians (2024)

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About WSP

For Patients and Families

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For Patients and Families

Pay My Bill

Paying A Bill

Online payments can be made through the Wright State Physicians Patient Portal, by either:

Entering the One-time Payment ‘QuickPay Code’, Statement ID or Access Code from your bill or statement.
Signing into your Portal Account.

Contact the Billing Department 937.245.7700

Wright State Physicians Patient Portal

To schedule and find out more about any of our services or locations, you can contact our scheduling department via call 937.245.7200.

SCHEDULE ONLINE — with the following clinics/providers:

Dermatology —725 University Blvd., Fairborn or400 Sugar Camp Cir., Ste. 101, Dayton*
- *Craig Rohan, MD (established patients follow-up appts.)

Internal Medicine — 725UniversityBlvd., Fairborn or 5678 Far Hills, Kettering*
- *Established patients

OB/GYN – 400 Sugar Camp Cir., Ste. 101, Dayton*
- *With the following providers:
  David Dhanraj, MD
  Allison Allread, APRN-CNP
  Alexis Garybush, APRN-CNP
  Angela Robinson, CNP

Sports Medicine– 725 University Blvd., Fairborn

Student Health– 725 University Blvd., Fairborn*
- *Active Wright State students only

* If you wish to become a patient please call 937.245.7200 for registration and appointment.

Make an Appointment

Insurance Questions

Accepted Insurances

Wright State Physicians offices accept most insurance plans. If you will be using health insurance to settle your account, you will be asked to present your current insurance card at each visit. If your insurance has out-of-pocket expenses (copays and deductibles), we will collect that amount at each visit. We will file an initial claim based upon the information that you have provided to us.

Office visits not covered by insurance and any required insurance copayments should be paid at the time of service. Payments can be made with cash, a personal check or most major credit cards. Patients should direct questions about insurance coverage and billing to their doctor’s offices.

The following insurance carriers cover services offered by most of our physicians:

List of Insurance Carriers

Aetna

Aetna (Medicare)

Ambetter Buckeye Health (Ohio Insurance Exchange Product)

Anthem BCBS Pathway (Exchange Product)

Anthem Blue Cross and Blue Shield

Anthem Medicaid

Anthem Senior Advantage (Medicare)

BWC & MCO’s – Ohio

Buckeye Community Health Plan (Medicaid HMO)

Buckeye Medicare Advantage Plan (HMO)

CareSource (Medicaid HMO)

CareSource Just4Me (Ohio Insurance Exchange Product)

Cigna

Healthspan

Humana

Humana Dayton HMOx

Humana Healthy Horizons (Medicaid HMO)

Humana Medicare Advantage HMO

Humana Medicare Advantage PPO

Medicaid (Ohio Traditional)

Medical Mutual of Ohio (Traditional and SuperMed)

Medical Mutual of Ohio Medicare AdvantageMedicare (Traditional)

MediGold (Medicare TPA)

Molina Healthcare of Ohio (Medicaid HMO & Medicare HMO)

Ohio Health Choice Plan

Rail Road Medicare

Tricare

UnitedHealthCare

UnitedHealthCare Community Plan (Medicaid HMO)

UnitedHealthCare Compass (Ohio Insurance Exchange Product)
- UnitedHealthCare Medicare Complete (Medicare)
- UnitedHealthCare Navigate (Ohio Insurance Exchange Product)

WellCare

Under state law, your insurance company has 45 days in which to process and pay the claim, request more information, or deny the claim and notify us of the decision. If they have not notified us within 90 days of the date of service, it will be assumed that your insurance coverage is no longer in effect and the unpaid balance will be your responsibility.

More information is available in ourPatient Policies brochure (PDF).

Patient Portal

Patient Portal Overview

The Wright State Physicians Patient Portal empowers you to manage your health anywhere, anytime.

You can:

Schedule and view appointments.
Billing –
- View your billing statements and balance.
- Make payments.
My Profile –
- Request prescriptions & refills.
- Retrieve test results.
- View personal health information.
- Update demographic information.
Communicate privately with your doctor by sending and receiving secure messages.
See your test results and health history.

Wright State Physicians Patient Portal

Support & Information

Patient Policies

The physicians and staff of Wright State Physicians (WSP) are pleased to welcome you to our facility. We hope that your visit will be a pleasant experience. WSP firmly believes that a good physician/patient relationship is based upon mutual understanding and open communication. The patient policies listed below have been developed to address any questions regarding a patient’s visit and account. If you have any questions please feel free to contact our office at 937.245.7200.

FORMS

Patient Consent
Patient Registration
Referral
Release of Medical Information

Geriatric Practice Health History

REGISTRATION

Please note that WSP practices use a digital check-in process; you will be provided a tablet upon arrival to complete all necessary information as indicated below.

Upon your initial visit to WSP, we will collect your billing and demographic information during the registration process. This information will include address, telephone number, social security number, date of birth, insurance information, employer information, emergency contact information, and other similar information. It is important that this information is kept up-to-date. Accordingly, at each subsequent visit, you will be asked to verify this information when you arrive for your appointment. In the event that any of the information has changed, you will be asked to update the information before seeing your physician.

MISSED APPOINTMENTS

Please give at least a 24 hour notice (one business day) if you will not be able to keep your appointment. If you are a new patient, failure to show up for your initial appointment may result in the inability to reschedule. Repeated failure to provide an appropriate notice or accumulating three no shows in a 12-month rolling period may result in dismissal from all WSP practices.

DISMISSAL

WSP views the provider-patient relationship as critically important to our ability to provide appropriate and safe care. If we are unable to create or maintain this relationship with you we may need to discontinue the relationship. Reasons that may deem this necessary include consistent no shows, noncompliance, or failure to adhere to our patient policies.

FMLA & DISABILITY FORMS

If you require FMLA paperwork or disability forms to be completed, there will be a $10 fee for each request and it will take up to 10 business days for completion. Payment is required prior to processing. They can be made via credit, cash or check.

MEDICAL RECORD REQUESTS

Upon receipt of a valid medical record release, your records will be released to you or the selected physician or facility of your choice. Please allow up to 10 business days for completion.

Download the Medical Release Form (PDF) here.

MEDICATION REQUESTS

Medication requests or refills will be processed within2 business daysand must be requested and filled within business hours Monday through Friday 8:30am-4:30pm. We recommend contacting your pharmacy or using the Patient Portal to submit requests for medications. Calls made to the office for any prescriptions after-hours or over the weekend will need to be called into the office during regular business hours or they can be requested electronically via the Patient Portal to be processed within the next 2 business days. The on-call physicians will not have access to patient medication information.

If you are prescribed opioids, you will be required to sign a controlled substance agreement annually.

PAYMENT FOR SERVICES

Payment for services provided is ultimately your responsibility. For your convenience, we accept cash, personal checks, Health Savings Accounts (HSA), Visa, MasterCard, AmEX and Discover. Our patient portal provides an easy and secure way to pay your bill. If you have a balance and are unable to pay it in full we can set you up on a payment plan. Our financial counselor can be reached at 937.245.7704.

HEALTH INSURANCE

If you will be using health insurance to settle your account, you will be asked to present your current insurance card at each visit. If your insurance has out of pocket expenses (co-pays and deductibles), we will collect that amount at each visit.

We will file an initial claim based upon the information that you have provided to us. Under state law, your insurance company has 45 days in which to process and pay the claim, request more information, or deny the claim and notify us of the decision. If they have not notified us within 90 days of the date of service, it will be assumed that your insurance coverage is no longer in effect and the unpaid balance will be your responsibility.

To view accepted insurances seeList of Insurance Carriers above on this page.

CARD ON FILE

WSP has a card on file policy, which is a convenient method of payment in which we securely store your Health Savings Account (HSA), credit or debit card on file for services that your insurance doesn’t cover. Please refer to the hand-out for more information on the process and terms for this agreement.

RETURNED CHECKS

The fee for a returned check is $30.00 payable by cash or money order. This will be applied to your account in addition to the insufficient funds amount. You may be placed on a cash only basis following any returned check.

WORKERS COMPENSATION CLAIMS

Several of our physicians provide services under workers compensation plans. You will need to provide us with the case number as well as the address to which the claims are to be filed.

SELF-PAY PLAN

If you are self-pay, you will be expected to pay for services rendered. You will be required to pay a $100 deposit on the day of service for any office visits. There may be additional charges for testing and other services rendered subsequent to your visit. You will be billed for these items. If you are having surgery, you will be expected to make mutually agreeable payment arrangements prior to receiving the service. You will be required to pay at least a $500 deposit prior to the procedure. If the service is considered elective, payment must be made in full prior to the services being rendered.

BILLING STATEMENTS

We have designed our billing statements to reflect the individual charges billed, the payments and adjustments related to those charges, and the balance due. Patients with a personal balance will receive a monthly statement. Payment is due upon receipt. All payments are applied to the oldest outstanding balance.

PAST DUE ACCOUNTS

Past due accounts cost both time and money; therefore, patients with delinquent accounts will be required to make payment at the time of service. If you are unable to make mutually agreeable payment arrangements, we will be glad to reschedule your appointment.

Those accounts failing to honor agreed upon payment terms will be sent to a collections agency and collection fees may apply. If your account is sent to a collection agency, patients and/or their immediate family members may be dismissed from all WSP practices for financial reasons. If this is occurs, you will be notified by regular and certified mail that you have 30 days to find alternative medical care.

TREATMENT FOR MINORS

While Ohio law considers anyone under age 18 to have the consent of a parent or guardian before receiving medical treatment, there are exceptions for emancipated minors and “mature minors” (over age 15 and who can show a health care provider that they have enough maturity and understanding to make medical care and treatment decisions). In addition, there are certain statutory exceptions whereby a minor who understands the risks and benefits of proposed care can consent to: emergency healthcare, limited outpatient mental health care, alcohol and drug abuse treatment, testing for STI/HIV/AIDS, and some family planning services. A separate consent form will be signed by the minor at every visit for these exceptions.

Non-Discrimination Statements

Wright State Physicians, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Wright State Physicians does not exclude people ortreat them differently because of race, color, national origin, age, disability, or sex.

To view the full statements, expand here:

Appendix A to Part 92—Nondiscrimination and Accessibility Requirements and Sample Nondiscrimination Statement: Discrimination is Against the Law

Wright State Physicians, Inc.:

Provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreters
- Written information in other formats is available as requested.
Provides free language services to people whose primary language is not English, such as:
- Qualified interpreters – Provided by patients insurance carrier as available or by Global to Local Interpreter Services. (513) 526-5011.
- Information written in other languages – Available as Requested through Interpreter Services.

If you need these services, contact the Compliance Officer at (937) 245-7280.

If you believe that Wright State Physicians, Inc. has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

Compliance Officer

By phone: (937) 245-7280,
By mail: Wright State Physicians Inc., 725 University Blvd., Fairborn, Ohio 45324

If you need help filing a grievance, our compliance officer is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available athttps://ocrportal.hhs.gov/ocr/portal/lobby.jsf

By mail:

U.S. Department of Health and Human Services
200 Independence Avenue SW., Room 509F, HHH Building
Washington, D.C. 20201

By phone:

1-800-868-1019, 800-537-7697 (TDD).

Complaint forms are available atwww.hhs.gov/ocr/office/file/index.html

Nondiscrimination statement for significant publications and signification communications that are small-size:
Wright State Physicians, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Appendix B to Part 92—Limited English Proficiency of Language Assistance Services

ATTENTION: If you speak:

Arabic
Korean
Chinese
Pennsylvania Dutch
Cush*te
Romanian
Dutch
Russian
French
Spanish
German
Ukrainian
Italian
Vietnamese
Japanese

Language assistance services, free of charge, are available to you. Call Global to Local Interpreter Services. (513) 526-5011.

Appendix C to Part 92—the Affordable Care Act Grievance

It is the policy of Wright State Physicians, Inc. not to discriminate on the basis of race, color, national origin, sex, age or disability. Wright State Physicians, Inc. has adopted an internal grievance procedure providing for prompt and equitable resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act (42 U.S.C. 18116) and its implementing regulations at 45 CFR part 92, issued by the U.S. Department of Health and Human Services. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities.

Compliance Officer

By phone: (937) 245-7280,
By mail: Wright State Physicians Inc., 725 University Blvd., Fairborn, Ohio 45324

If you need help filing a grievance, our compliance officer is available to help you.

Any person who believes someone has been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for Wright State Physicians, Inc. to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance.

Procedure:

Grievances must be submitted to the Section 1557 Coordinator within (60 days) of the date the person filing the grievance becomes aware of the alleged discriminatory action.
A complaint must be in writing, containing the name and address of the person filing it. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought.
The Section 1557 Coordinator (or her/his designee) shall conduct an investigation of the complaint. This investigation may be informal, but it will be thorough, affording all interested persons an opportunity to submit evidence relevant to the complaint. The Section 1557 Coordinator will maintain the files and records of Wright State Physicians relating to such grievances. To the extent possible, and in accordance with applicable law, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know.
The Section 1557 Coordinator will issue a written decision on the grievance, based on a preponderance of the evidence, no later than 30 days after its filing, including a notice to the complainant of their right to pursue further administrative or legal remedies.
The person filing the grievance may appeal the decision of the Section 1557 Coordinator by writing to the (Administrator/Chief Executive Officer/Board of Directors/etc.) within 15 days of receiving the Section 1557 Coordinator’s decision. The (Administrator/Chief Executive Officer/Board of Directors/etc.) shall issue a written decision in response to the appeal no later than 30 days after its filing.

The availability and use of this grievance procedure does not prevent a person from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the U.S. Department of Health and Human Services, Office for Civil Rights. A person can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, available athttps://ocrportal.hhs.gov/ocr/portal/lobby.jsf

By mail:

U.S. Department of Health and Human Services
200 Independence Avenue SW., Room 509F, HHH Building
Washington, D.C. 20201

By phone:

1-800-868-1019, 800-537-7697 (TDD).

Complaint forms are available atwww.hhs.gov/ocr/office/file/index.html

Such complaints must be filed within 180 days of the date of the alleged discrimination. Wright State Physicians, Inc. will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Prepare For Your Visit

Before Scheduling

To help ensure a smooth check-in and billing process, we encourage you take these steps before your visit:

Confirm your insurance is accepted by Wright State Physicians by checking our list of accepted insurance plans or by calling your insurance company to find out if it has a contract with Wright State Physicians. Note: Our Psychiatry department does not take any insurance. See their FAQ page for more information.
Check your insurance plan to find out what is and isn’t covered and whether or not your service required authorization.
If required by your insurance company for the desired service(s), obtain a referral. Discuss this with your primary care physician prior to scheduling an appointment with one of our specialists.
Confirm the copay amount for your visit, as well as any unmet deductible amount.
Be aware of your coinsurance and out-of-pocket maximum.
Update your coordinate of benefits with your insurance plan.
If you do not have insurance, review our financial assistance options.

Before Your Appointment

Depending on the reason for your doctor’s visit, this checklist can help you prepare.

Gather documents to bring to your doctor’s visit:
- Copies of any tests, x-rays or medical histories relating to your medical problem.
- Completed medical history questionnaire.
- A list of all current medications taken on a regular basis, including over-the-counter and herbal medications.
Review an special directions from your doctor about diet or medication restrictions.
Ask friends or relatives to accompany. [We do request guests are limited for COVID social distancing purposes.]
Bring a sweater or coat if you tend to get cold in A/C spaces.

During Your Appointment

To make the most of your appointment, be sure to ask your doctor any questions or express any concerns you have.

Not sure what to ask? Find suggestions:

About Your Symptoms or Diagnosis

What is the disease or condition?
How serious is my disease or condition and how will it affect my home and work life?
What is the short-term and long-term prognosis for my disease or condition?
What caused the disease or condition?
Is there more than one disease or condition that could be causing my symptoms?
Should I be tested for a certain disease or condition?
What symptoms should I watch for?
How can I be tested for a disease or condition, and what will these tests tell me?
What tests will be involved in diagnosing my disease or condition?
How safe and accurate are the tests?
When will I know the test’s results?
Will I need more medical tests?
Do I need a follow-up visit and if so, when?
Do I need to take precautions to avoid infecting others?
How is the disease or condition treated?

About Your Treatment

What are my treatment options?
How long will the treatment take?
What is the cost of the treatment?
Which treatment is most common for my disease or condition?
Is there a generic form of my treatment and is it as effective?
What side effects can I expect?
What risks and benefits are associated with the treatment?
What would happen if I didn’t have any treatment?
What would happen if I delay my treatment?
Is there anything I should avoid during treatment
What should I do if I have side effects?
How will I know if the medication is working?
What would I do if I miss a dose of medication?
Will my job or lifestyle be affected?
What is my short-term and long-term prognosis?

If You Need Surgery

Why do I need surgery?
What surgical procedure are you recommending?
Is there more than one way of performing this surgery?
Are there alternatives to surgery?
How much will surgery cost?
What are the benefits of having surgery?
What are the risks of having surgery?
What if I don’t have this surgery?
Where can I get a second opinion?
What kind of anesthesia will I need?
How long will it take me to recover?
What are your qualifications?
How much experience do you have performing this surgery?
How long will I be in the hospital?

Health & Safety Tips

How Patients Can Take an Active Role in Their Care and Safety
Participating in your own care has many advantages. Your doctor, nurse and other healthcare providers welcome your involvement. Below, find tips for you and your family to help us ensure your health and safety:

Tip #1: Be involved in your healthcare.

To be involved in your healthcare:

Take part in all decisions about your treatment
Share any special care needs that you have
Ask a trusted family member or friend to accompany you when you visit your doctor if you are too ill or stressed to participate yourself
Remember you are the center of the healthcare team.

Tip #2: Speak up if you have any questions or concerns.

You have a right to question anyone who is involved with your care. To be sure you have all the information you need, it can help to write down questions to ask for the next time you visit the doctor.

Tip #3: Identify yourself.

Be sure the healthcare professional asks your name and birthdate. Also, don’t hesitate to inform the healthcare professional if you think he or she has confused you with another person.

Tip #4: Ask healthcare workers tell you what they plan to do before you consent to any procedure.

Healthcare workers should tell you what they plan to do before any procedure. Also, you can remind healthcare workers who have direct contact to wash their hands. Handwashing is an important way to prevent the spread of infection.

Tip #5: Bring your doctor a list of your medications and mention any allergies you have.

This list should include all over-the-counter medications, home remedies, and herbal medications including tea, vitamins and weight gain or loss products such as shakes, pills or bars. Sometimes they can be dangerous when you take them with other medications.

Know what medications you are taking, why you are taking them, and potential side effects. Let the doctor and nurse know of any allergies and type of reaction or side effects you have. Also be sure to ask questions about the medications you are prescribed during your appointment.