Thank you for choosing Humble Family Practice as your primary care provider. With a mutual commitment between physician and patient, we will provide you and your family with quality health care and medical services.

Below you will find Humble Family Clinic’s office and financial policies. We invite your feedback on ways we can improve either these policies or the care we provide you and your family.

Office Visit Policy
Refills and Medicine Policy
No Show/Cancellation Policy
Insurance and Payment Policy
Medicare Policy
Correspondence and Medical Records Policy
HIPAA & In-Office Medical Records Privacy Policy
Patient Forms
Attorney Referrals/Letter of Protection Policy
Hospitalization Policy
Complete/Annual Physical Examination Policy
Treatment of Minors Policy
Lab Results
Emergencies

Office Visit Policy

Office visits are meant to protect your health safety, to ensure the effectiveness of your treatments and to check for any side effects from your medications. Your specific wellness needs will determine the frequency of your office visits.

Once you and Dr. Carpenter determine your wellness needs, all medications will be prescribed according to the next scheduled office visit. Refills will be given in accordance to office visit frequency.

Office visit once per year

• Annual physical exam or well woman exam, depending on age and gender

Office visit every 6 months

• Stable hypertension, diabetes and treatment of cholesterol
• Long-term need of sleep aids or arthritis medications

Office visit every 3 months

• Diabetes with average fasting glucose >120 of A1c over 6.5, or 2 hour glucose over 140
• Heart condition or carotid artery blockages that are not improving
• High blood pressure >140/90
• LDL (bad cholesterol) over 70 (mg/dL) for patients with diabetes, heart/circulation condition and memory loss

Office visit every week or every few days

• Critical and unstable medical conditions

Always bring a current list of all your medications, with the exact dosages, with each office visit.

Refills and Medicine Policy

During your office visit with Humble Family Practice, our physician will write your prescription with enough refills to last until your next visit. All prescription refills require you to schedule an appointment to reduce the possibility of medication errors. This policy is meant to ensure the health and safety of our patients.

Follow-up appointments to monitor your progress on these medications are very important. To avoid any difficulties, be sure to call us well in advance of the time your refill is needed for an office visit. That way, we can provide the most suitable treatment for your healthcare needs.

No Show/Cancellation Policy

Failures to fulfill office appointments (“No-Shows”) will be recorded in patients’ charts. To cancel an appointment with your family doctor, we require 24 hours notice. This policy makes it possible for us to see other patients who might not otherwise be treated. There is a $20.00 charge for appointments canceled without at least 24 hours (1 business day) notice.

We at Humble Family Practice realize circumstances might cause you to arrive late or miss an appointment. If you are unable to keep your appointment, please call the office 24 hours in advance to cancel.

Insurance and Payment Policy

Verify Insurance

Before your first office visit, it is essential to verify your insurance coverage. If you changed insurance since your last visit, please call your insurance provider to confirm that Humble Family Practice or Doctor David Carpenter is accepted under your insurance.

If your insurance company requires you to pick a Primary Care Physician (PCP), Dr. David Carpenter must be the PCP listed on your insurance card.

Although Humble Family Practice’s friendly staff is here to assist you, your health insurance contract is between you and your insurance company. Any questions or complaints regarding your coverage should be directed to your insurance carrier.

Each time you arrive for your appointment, you will be asked to present your insurance card and verify your address and all phone numbers. While this may seem like an inconvenience, we have found that often the insurance companies make slight changes to coverage that are important for us to know. Please be prepared to present this information when checking in for your appointment.

Co-pay, Co-Insurance, and Deductible Payments

Dr. David Carpenter and Humble Family Practice are contracted with most insurance plans. However, if we do not carry your plan, payment is necessary at the time of service. If you do not have an up-to-date insurance card, self-pay fees for each visit is required until we can verify your coverage. You will have to file with your insurance company for reimbursement of payment to our office.

If Doctor David Carpenter is a participating provider for your insurance company, Humble Family Practice will file the office visit charges. You must pay your co-pay and/or deductible amounts when you check in for your appointment. If we cannot reach your insurance company to verify your coverage, payment in full is required at the time of your visit.

In the event of an emergency procedure during your office visit, you must pay any co-insurance before you leave the clinic. Self-pay patients must provide 100% payment at the time of service.

Non-covered Services

Please be aware that some services might not be covered by your particular insurance plan. Some, or even all, of the services you receive may be non-covered or considered unnecessary by the insurer. It is very important to verify your coverage – non-covered services must be paid for in full at the time of the service. This is particular many lab and x-ray services for most carriers.

Claims Submission

Your insurance company might need you to supply certain information directly. It is your sole responsibility to comply with their request.

Account Balance Fees and Collection

All accounts with a balance more than 60 days overdue will be assessed with a monthly service charge of $25.00. Partial payments are not accepted unless otherwise negotiated with Humble Family Practice billing office. Unpaid balances 90 days overdue will be referred to a collection agency.

Billing Office

If you have questions or concerns about your statement, or need to set up past due balance payment arrangements, please feel free to contact our billing office at 281-446-1014 .

Medicare Policy

Humble Family Practice is a Medicare Participating Provider, which means Medicare tells us the amount to charge for our services. Of the amount Medicare allows us to charge, Medicare will pay 80% and you (or your supplemental insurance) will pay 20%.

In addition, Medicare has a yearly deductible that you need to pay before Medicare pays. Your co-pay (which is 20% of Medicare’s allowed amount) is due at the time of your appointment, unless you have a supplemental insurance policy.

If you have a supplemental insurance policy, we will file with that secondary insurer after we receive a response from Medicare. You will receive a bill from us the month following Medicare’s response. We allow 60 days from the date Medicare responds for your supplemental policy to pay. After 60 days, the balance becomes your responsibility.

Please bring your Medicare card with you so we can copy it for our records. If your spouse is employed and has insurance covering you, or if you have other insurance that is primary over Medicare, please bring those insurance cards as well.

Correspondence and Medical Records Policy

Telephones are answered throughout our open office hours. Humble Family Practice staff is happy to answer your questions about office policy, billing and insurance, and scheduling appointments. For questions, please call 281-446-1014.

Because quality medical care is so important, no medical consultations will be given by phone. If you need to speak with the doctor, you can schedule an office visit to discuss your concerns, problems or test results. We will also be happy to schedule an appointment with your medical provider to address any healthcare concerns.

Release/Transfer of Medical Records

We require an administrative fee for the duplication, transfer and release of a patient's medical chart. This fee covers the cost of duplication and any applicable postage to forward those medical records. Prior authorization from the patient is required before any copies are released. Humble Family Practice’s fee policy for the transfer of records is in accordance as required by the Medical Practice Act - Texas Administrative Code.

Records Release

Medical Record releases will be completed within fifteen (15) business days. As a courtesy, records will be released to any physician upon your written request and authorization. Please complete the Permission to release PHI (personal health information) form.

There is a charge for personal records release requests. The usual fee is $25.00 for the first twenty pages, $0.50 each additional page. If an affidavit is requested, a reasonable fee of $15.00 will be charged for execution.

Medical and Legal Forms Completion

Our office charges $25 for the completion of forms. These charges are the patient’s responsibility.

HIPAA & In-Office Medical Records Privacy Policy

Humble Family Practice complies with HIPAA, the federal health safety act. All patients must sign a HIPAA Notice of Privacy form to be treated. Please read and print a copy of our privacy policy, which is located here. And sign the HIPAA Notice of Privacy form, which is located here.

Patient Forms

To minimize delays and wait times for all patients, we have standard patient information and medical history forms posted below. Please print them, fill them out and bring them with you to your scheduled appointment. All forms are in Adobe Acrobat format. If you cannot view the links below, you might need to download the Acrobat Reader (free).

• Patient Information Form
• Patient Roles and Responsibilities
• HIPAA Notice of Privacy

Attorney Referrals/Letter of Protection Policy

Dr. David Carpenter does not accept Attorney Referrals for patients in litigation because of accidents and injuries.

Hospitalization Policy

We admit our patients to Northeast Memorial Hospital and Kingwood Hospital. Doctor Carpenter does not manage patients’ care while they are hospitalized. He has partnered with Dr. Luu and Dr. Tiu to admit services.

Dr. David Carpenter’s Hospital privileges include:

• St. Luke’s Hospital, The Woodlands
• Memorial Hermann Northeast Hospital
• Kingwood Medical Center, HCA

Complete/Annual Physical Exams Policy

We highly recommend that all our patients have regular Complete Physical Exams (Annual Screening/Preventative Visits, etc.) every 1-2 years.

It is your responsibility to verify that your insurance will reimburse preventative visits if you are scheduled for such. Be advised that some insurance companies routinely do not cover preventative visits (Medicare & some Blue Cross plans especially).

Treatment of Minors Policy

Patients under the age of 18 must have a parent/legal guardian consent in order to be seen by Dr. David Carpenter or a Physician Assistant. Without parental consent, the child’s appointment must be rescheduled.

Lab Results

If you have lab work performed , please expect to receive your results by mail with in three to five business days. Lab work results are sent to your home address unless you specify an alternative address.

In the event Dr. David Carpenter and Physician Assistants have further questions or require additional lab work, Humble Family Practice will contact you to schedule an office visit. An office visit will automatically be required to review ECG/MRI/CAT Scan studies with your Dr. Carpenter or a Physician Assistant.

Emergencies

If you have a medical emergency, call 911 or proceed to the nearest emergency room. Humble Family Practice has full-time coverage for patient minor emergencies that occur after hours. If a problem arises when our office is closed, simply call the office at 281-446-1014 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 performed after hours.