Patient Information

Thank you for choosing Sullivan Digestive Center to serve your gastroenterology needs. It is our goal to prepare you for your visit with us to ensure that we deliver to you the best care possible.

Appointments and Referrals:

Your appointment has been scheduled. Please remember that some insurance companies require a referral or prior authorization from your primary care provider. Unfortunately, we cannot see you without a valid referral, so please check with your insurance company or primary care provider to see if a referral is required.

Due to high volume of patients we do not accept walk-ins. If you have a question for our nurses regarding your prep or procedure please call the office and we will have a nurse to call you back as soon as possible. Please obtain all prescriptions and refills at your office visit.

On the day of your visit, please bring the following information with you:

Insurance card or proof of insurance – if you do not bring this with you, you will be considered as self pay and be responsible for all payments.

A photo identification

Completed and signed new patient forms

Medications or a completed medication list.

What to expect:

You will be scheduled an appointment with one of our providers prior to having any procedures scheduled.

A brief history and physical will be performed at this office visit.

Your provider will discuss with you the risks and benefits of any treatment options or procedures.

If it is determined you need a procedure, one of our clinical specialist will provide you with written instructions and discuss with you how to prepare for your procedure.

Scheduling your procedure:

After your office visit, you will be directed to our check out window to schedule your procedure. You will be given options for procedure days and payment plans.

Labwork:

It is common for our practitioners to order recent labs on our patients. After you have checked out at the checkout window, you will be directed to the Synergy lab draw station here in our facility. The lab is owned by Synergy Laboratories and you will receive a bill from Synergy Laboratories for any labs drawn. If you are aware that your insurance requires your labwork to go to a specific lab, please make the person drawing your labs aware of this information. If you have any billing questions related to your lab services you will need to contact Synergy. After you have had your labs drawn, you will be free to leave. Results will either be mailed to you or discussed at your next office visit.

Transportation to your procedure:

Due to the fact that you will be sedated for your procedure, you must bring a family member or friend to drive you home after your procedure.

Taxi drivers or other forms of public transportation are unable to accept the responsibility for taking you home.

Family or friends:

Those accompanying you may wait in the reception area during your procedure. They may, at times, be able to sit with you after you are admitted and they will be called to the recovery area to sit with you after your procedure. TV is provided in our wait areas.

If they are leaving the facility, they must provide a telephone number where they may be reached.

Please note that your support person should be nearby when you reach the recovery room so he or she can talk to the discharge nurse about the findings of your procedure

On the day of your procedure:

Please follow all directions on the prep sheets that were given to you at your office visit.

Please do not bring any medications with you unless instructed to do so by a nurse. Sullivan Digestive Center is not responsible for medications that may be lost or stolen.

Please do not wear any jewelry. Sullivan Digestive Center is not responsible for any personal items that may be lost or stolen.

Please wear comfortable clothing. Avoid wearing any clothing that fits tightly as bloating is expected after most procedures.

Any items such as dentures, glasses or hearing aids will be placed under your stretcher prior to your procedure.

With the admitting process, the procedure, and the recovery period, be prepared to stay for 3 – 4 hours. Your procedure time depends on the type of procedure and the amount of sedation you receive. We make every attempt to stay on a schedule, however, at times some patients may require more time and care. Your patience is greatly appreciated and our staff will see that everyone receives the care and attention they need.

Prior to your procedure:

You will be escorted to the prep area by one of our technicians for admission where you will be asked about personal effects, any medical conditions and confirmation of your medication use.

You will then be escorted to your own private prep room to change into a gown provided.

If you are having a colonoscopy, you will receive enemas prior to being taken back for your procedure.

An IV will be started. Your anesthesia provider will speak with you and perform a pre-anesthesia evaluation to determine your anesthesia needs. Your physician will also speak with you prior to your procedure to make sure all of your questions have been answered and that nothing has changed with your health since you were last here.

After your procedure:

You will be taken to our recovery room where your vital signs will be monitored and you will be allowed to recover from the sedation.

You will be given something to drink and your IV will be removed.

Qualified Nursing Staff will be going over your discharge instructions, give you any prescriptions written by your physician and answer any further questions you may have.

If you have any biopsies performed during your procedure, you will be called or sent a letter, with those results within 7 to 10 days.

Whoever accompanied you to your procedure may help you get dressed, or one of our nurses will assist you if you prefer.

You will be taken to your car via wheelchair.

One of our nurses will call you after you arrive home to ensure you are resting comfortably and having no problems.

Emergency Care:

If you experience any problems, please contact our office during normal business hours. After hours, please call Indian Path Hospital 423-857-7000 and ask for the physician on call for Sullivan Digestive Center. If at any time, you feel that your need is emergent, please call 911 immediately or go to your nearest emergency department. A physician will be available to you 24 hours a day, 7 days a week at any local emergency room.

Medication Refills/ Prior Approval:

Please seek any necessary refills at your office visits. No refills will be called in unless emergent.

Unfortunately, some medications require prior approval from your insurance carrier. We will attempt to obtain this for you; however, some prior approvals are denied the first time and require a letter of medical necessity be sent. This process may take up to 7 to 10 days depending upon call volume. We will contact you and your pharmacy as soon as approval is obtained.

As we specialize in the practice of gastroenterology, our practitioners do not treat chronic pain or anxiety. You are to see your primary care providers for any pain or anxiety medications you may require

Can’t Keep Your Appointment? :

We request a 24 hour notice if you are unable to keep your appointment. We understand that scheduling conflicts occur from time to time however, three or more missed appointments may result in dismissal from our practice. Your understanding and cooperation helps us to provide available appointments for patients who urgently need them.

Medical Record Request/Form Completion:

During your treatment with our facility you may require FMLA forms, disability forms etc. to be completed. If you request a copy of your medical records there will be a $20.00 charge. We can mail these records to your home address or you may pick them up at our office.

Providing the personal care you deserve since 1984...Sullivan Digestive Center.

Disclosure of Ownership

The Endoscopy Center of Kingsport doing business as Sullivan Digestive Center

Is owned and operated by: Michael J. Sullivan, M.D., 2204 Pavilion Drive, Kingsport, TN 37660

Licensed by: State of Tennessee Department of Health, Board for Licensing Healthcare Facilities

Certified by: Centers for Medicare and Medicaid Services (CMS)

This corporation is for profit.

Any further questions regarding ownership may be directed in writing to:

Administration

Sullivan Digestive Center

2204 Pavilion Drive, Suite 108

Kingsport, TN 37660

RIGHTS:

A Patient has the right to considerate, dignified and respectful care given by competent personnel and be free from all forms of abuse and harassment.

A Patient has the right, upon request, to be given the name of his attending practitioners, the names of all other practitioners directly participating in his care, and the names and functions of other health care persons having direct contact with the patient, and also the right to change their provider if other qualified providers are available.

A Patient has the right to personal privacy concerning his own medical care program. Case discussion, consultation, examination, treatment, and medical records are considered confidential and shall be handled discreetly.

A Patient has, at any time, the right to approve or refuse, confidential disclosures and records of his medical care and individually identifiable health information, except as otherwise provided by law or third party contractual arrangement.

A Patient has the right to participate in decisions involving his health care except when such participation is contraindicated for medical reasons.

A Patient has the right to know what Sullivan Digestive Center rules and regulations apply to his conduct as a patient.

A Patient has the right to expect emergency procedures to be implemented without unnecessary delay.

A Patient has the right to full information, in layman’s terms, concerning diagnosis, evaluation, treatment and prognosis, including information about procedures and expected outcomes; alternative treatments and possible complications, before the procedure is performed. When it is not medically advisable to give the information to the patient, the information shall be given on his behalf to the person designated by the patient or to a legally authorized person.

Except for emergencies, the practitioner shall obtain the necessary informed consent prior to the start of a procedure.

A Patient, or if the patient is unable to give consent, a legally authorized person, has the right to be advised when a practitioner is considering the patient as a part of a medical care research program. The patient or responsible person shall give informed consent prior to participation in the program. The patient or responsible person may refuse to continue in a program to which he has previously given informed consent.

A Patient has the right to refuse drugs or procedures. A practitioner shall inform the patient of the medical consequences of the patient’s refusal of drugs or procedures.

A Patient has the right to medical and nursing services without discrimination or reprisal based upon age, race, color, religion, sex, national origin, handicap, or disability.

Sullivan Digestive Center shall provide the patient, or patient designees, upon request, access to the information contained in his medical records, unless the attending practitioner for medical reasons specifically restricts access.

A Patient has the right to expect good management techniques to be implemented within Sullivan Digestive Center. These techniques shall make effective use of time for the patient and avoid personal discomfort of the patient.

When an emergency occurs and a patient is transferred to another facility, the responsible person shall be notified. The institution to which the patient is to be transferred shall be notified prior to the patient’s transfer.

A Patient has the right to examine and receive a detailed explanation of his bill.

A Patient has the right to expect that Sullivan Digestive Center will provide information for continuing health care requirements following discharge and the means for meeting them.

A Patient has the right to be informed of his rights prior to or at the time of admission.

A Patient who does not speak English shall have access, where possible, to an interpreter.

A Patient has the right to good quality care and high professional standards that are continually maintained and reviewed, and to voice suggestions, complaints or grievances regarding treatment or care that is (or fails to be) furnished. Grievances or Complaints may be reported to the following:

Sullivan Digestive Center

Penny Vaughn, Administrator

2204 Pavilion Drive, Suite 108, Kingsport, TN 37660

Phone: 423-392-6100

Your Tennessee State Representative

State of Tennessee Department of Health

Cordell Hull Building, 425 5th Avenue North, Nashville, TN 37243

Bureau of Health Licensure and Regulation

(615) 741-8402

State Web site:

tennesseeanytime.org/government.html

Tennessee Health Care Facilities Complaint Hot-Line

1-877-287-0010

Medicare Ombudsman Web site

www.medicare.gov/Ombudsman/resources.asp

Medicare:

www.medicare.gov or call 1-800-MEDICARE

(1-800-633-4227)

Office of the Inspector General

Office of Public Affairs

Department of Health and Human Services

Room 5541 Cohen Building

330 Independence Avenue, S.W.

Washington, D.C. 20201

Phone:

202 619-1343

Fax:

202 260-8512

E-Mail:

paffairs@oig.hhs.gov

These Patient Rights and Responsibilities may be exercised by any legal representative who has been designated, in accordance with State law, by a patient who has not been adjudged imcompetent under applicable State laws.

OR

By any legal representative who has been appointed by state law to act on the behalf of a patient

who has been adjudged incompetent by the courts under applicable State laws.

RESPONSIBILITIES

A Patient is responsible to keep appointments or telephone the Center when he/she cannot keep a scheduled appointment.

A Patient is responsible for providing information about past illnesses, hospitalizations, over the counter and prescription medications, allergies and other matters relating to their health with them at the time of their visit. Patients should ask questions immediately if they feel they cannot follow the instruction.

While practicing at this Center, the physician is obligated to exercise good medical judgment in order to help each patient. It is each patient’s responsibility to cooperate in the treatment program that the physician specifies and participate in their own care.

This Center has a privacy policy, which requires patients to identify those individuals who are authorized to receive reports and test results. No information will be given to anyone who has not been authorized to receive information unless it is necessary for continued or emergency care by another provider.

All Patients are expected to be considerate and respectful of other patients, their family members, and the property of other persons, as well as, the healthcare professionals and staff.

Duly authorized members of a patient’s family are expected to be available for review of the patient’s treatment in the event that the patient is unable to communicate with the physicians or nurses.

A patient has a responsibility to provide information necessary for insurance processing of his/her bills, accept personal financial for any charges not covered by insurance, to be prompt about payment of Center bills, and to ask any questions he/she may have concerning bills.

A Patient has a right to have and provide advance directives; however, if he/she is having a procedure done in this facility and signs a consent form, we cannot honor DNR orders or Living Wills during the procedure time.

Communication between a patient and our team is an important element in good health care. If the patient is concerned about or displeased with any aspect of their care, we ask that he/she first discuss the problem with the nurse or physician. We strongly encourage each patient to complete their patient questionnaire so that we can continually improve our services.

All patients having procedures at Sullivan Digestive Center shall have the responsibility to bring a licensed driver to drive them home after sedation and remain with him /her for twenty four hours as deemed necessary by their provider.

At Sullivan Digestive Center, we do not want financial hardship to come between you and appropriate care. If you find yourself in financial difficulties, please call our billing office to arrange a method of payment.

All co-payments are due at the time of your visit. We will ask you to verify your current address and insurance information at the time of each visit.

Please remember that some insurance companies require a referral or prior authorization from your primary care provider. Unfortunately, we cannot see you without a valid referral, so please check with your insurance provider to see if a referral is required.

Please be advised that when you have a procedure performed you will receive three separate bills, each will have the same account number. You will receive one bill for the professional services rendered by the physician who will be performing your procedure. You will also receive a bill from the Sullivan Digestive Center which is the facility charge for your procedure. Lastly, you will receive a bill from your anesthesia provider for services provided by the anesthesia care team. Please contact our office for questions regarding any of these services.

If biopsies are performed during your procedure or blood tests are performed, these specimens are sent to outside laboratories for processing. Depending on what your insurance pays, you may receive a bill from the outside laboratory for their services. Please direct questions regarding these charges directly to the individual laboratory.

These charges are similar to the charge you would receive if your procedure had been performed in the hospital. Please be advised it is the patient's responsibility to make sure that any procedure you are having is a covered benefit.

We will submit all charges to your insurance company for you and wait for their payment. After that payment has been received you will receive a statement of your account showing the amount due, per your insurance company.

If you need to make arrangements to pay off the balance, we will be happy to assist you with a payment plan. We do not charge finance charges or late fees, therefore we request that a payment be made to all accounts on a regular basis. If you are unable to make a scheduled payment, please call us so that you will not receive a collection letter.

We also accept Visa, Discover and MasterCard to make payments, or if you wish, to pay the balance of the account.