We welcome you as a patient and appreciate the opportunity to provide you with medical services. The information below is designed to introduce you to our services and to answer your questions about our clinic and our policies.
Dermatology– You do not need a referral unless your insurance carrier requires one.
Endocrinology– You can be seen without a referral, however Dr. Khairalla prefers you have one. Appointments are made immediately for the patient with a doctor’s referral. Dr. Khairalla requires all medical records to be here at least one week prior to the patient’s appointment.
If you do not have a referral, Dr. Khairalla must review your medical records before an appointment can be made. This allows the doctor to thoroughly review your history in advance and ensure that an endocrinology visit is appropriate for you.
General Surgery– Most often, you will be referred to the general surgeon by another physician. Under special circumstances, however, our surgeons will see you if you do not have a physician referral.
Getting Ready for Your Visit
In order for us to provide the best care for you, it is very important that you bring the following items to your visit:
- List of Medications – Please include name, dosage (strength) and frequency (e.g. daily, 3x/day)
- X-Rays from other groups or hospitals that would pertain to your visit with us (bringing a disc with the images is acceptable). (examples: CT scans, ultrasounds, etc.)
- Medical records and reports that may be helpful (example: Pathology reports, operative reports, etc.)
- Information about what treatments and medications have been tried in the past
- Insurance information and card
- A photo ID
- Health Questionnaire and Patient Registration Forms – Quickly and conveniently access our forms via our Web Portal.
For your first appointment you will be asked to fill out information forms. When possible, these forms will be sent to you by mail before your appointment. Please fill these out completely, sign and date them.
Bring your insurance card to your appointment so we may make a copy for your file. If you need assistance, please ask our receptionists. If your insurance requires a referral by your primary care physician, this must be done prior to your appointment with us.
It is helpful if you bring any test results and x-rays to your appointment.
You must bring a list of your current medications to every appointment at Midlands Clinic.
On all subsequent visits, please notify us of any address, phone number or insurance changes.
Office Policies and Insurance
We will file insurance claims as a courtesy for any non-cosmetic services we provide. Please provide our office with your current medical insurance card and information. Please also remember that your insurance contract is between you, your employer and the insurance company. Therefore, it is your responsibility to know your insurance coverage and which services are covered in your contract. Midlands Clinic cannot guarantee payment of your claim. If your insurance does not pay, you will be responsible for your financial obligation to your doctor at Midlands Clinic.
You are responsible for insurance deductibles and co-payments at the time services are rendered. Please confirm with your insurance company the amount of your co-pay. Full payment of services is due at the time services are rendered if we do not participate with your insurance company or if you do not have insurance coverage. We accept cash, personal checks, as well as Visa, MasterCard, and Discover.
If there is a balance on your account after your insurance has paid, you will receive a bill from us within 10 days. After 60 days, if your account is past due, it will be sent to in-office collections for review. If it is still past due after 90 days, it will be referred to an outside collection agency. In the event that you do not pay the balance, collection and attorney fees could be added to the balance of the account. You will be asked to make payment arrangements prior to scheduling another appointment at Midlands Clinic. Please contact our patient account representatives if you have any questions or to discuss making a payment at 605-217-5500.
Because we are extending a credit to our patients with insurance, we require a social security number from our patients, or their responsible party. If you do not wish to provide your social security number, you will need to make payment in full for services rendered.
We require 24-hours notice in cancelling an appointment. For missed or late-cancelled appointments, we reserve the right to charge a fee that will be applied to your next visit. For patients who have missed three or more appointments, Midlands Clinic reserves the right to dismiss that patient.
Because cosmetic procedures are not covered under medical insurance, you are responsible for the full cost of any cosmetic procedure.
Existing patients can always communicate with us via the secure messaging feature within our Patient Portal.
If you are not an existing patient, and you have a problem or a question, please don’t hesitate to contact us or call 605-217-5500. Our office is staffed with experienced and knowledgeable professionals to answer your questions.