What to Bring to Your Appointment

• Your insurance card
• Physician referral forms, if required by insurance
• List of prescriptions and/or over-the-counter medication, including dose and frequency
• Information about your medical and surgical history
• Recent x-rays or relevant records

Insurance

We will submit claims to your insurance company, however, it is your responsibility to pay any deductible, coinsurances or any other balance that is not covered by your plan.

Medicare patients are required by law to pay their annual deductible. HMO patients must obtain written pre-authorization from their primary physicians and are required to pay the co-payment at the time of service.

We know questions can arise on insurance matters and these should be discussed with our billing office. We will be happy to help you receive maximum benefits; however the agreement of the insurance company to pay for medical care is a contract between you and your insurance company.

Emergency Care

We recognize that you can have an emergency situation arise, and we will do our best to respond to your problem promptly. In the event of a severe situtation, or one in which you are in doubt, go immediately to the emergency room of the nearest hospital and ask them to contact Dr. Glazier. If the situation is not that severe, but one where you wish to contact Dr. Glazier, please telephone and the doctor will be in touch with you either directly or through office personnel giving you instructions on where to meet for urgent care.

Prescriptions and Renewals

All prescriptions and authorizations for renewals should be requested during normal office hours.

Fees and Payments

We make every effort to keep down the cost of your medical care. You can help by paying upon completion of each visit. Other arrangements can be made with our office manager depending upon special circumstances.

If your insurance requires an office visit copayment, that copayment is due at the time of your visit. If our office has to bill you for your copayment, there will be a $5 billing fee attached to each statement sent.

Please note: Our office requires two business days (48 hours) notification for cancellation of patient visits. A $25 charge will be implemented for failure to cancel scheduled appointments two business days prior to scheduled visits.

Hospital Affiliations

Dr. Glazier has affiliations with the following hospitals:

• UMass Memorial Hospital
• Med City (also referred to as Worcester Medical Center or St. Vincent's)
• Hubbard Regional Hospital

Patient Forms

• Medical History / Family Questionnaire
• Patient Insurance Information
• Patient Financial Policies
• Acknowledgement of Receipt of Notice of Our Privacy Practices Information

HIPAA Notice of Privacy Practices

Wayne B. Glazier, MD, PC, Urology

Main office
85 Prescott Street
Suite 304
Worcester, MA 01605
Tel: 508.753.7259
Fax: 508.753.9577
(After hours telephone number: 866.753.5259)
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72 Cudworth Road
Webster, Massachusetts 01570
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159 Union Street, Suite 104
Marlborough, MA 01752
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