Colonial Internal Medicine Associates, Fredericksburg, VA logo for print
Fredericksburg Location:
125 Olde Greenwich Drive, Suite 300, Fredericksburg, Virginia 22408
Stafford Location:
392 Garrisonville Road, Suite 106, Stafford, Virginia 22554
Phone (both locations): 540-374-5599

Colonial Internal Medicine Associates, Fredericksburg, VA

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Frequently Asked Questions

We have divided our most Frequently Asked Questions relating to Internal Medicine into the 3 sections below for ease of access:

Section I

Patient Services:

  1. What if I am sick or have an emergency, can I be seen quickly?
    • We are there for all your health needs and feel it is very important you have access to your physician in an emergency or when you become ill. We make it a point daily to set aside visits on our calendar for sick patients that may be calling that day when they are ill. We see patients as a team for urgent care and our board certified physician assistants are more than capable of seeing you as well when you are ill or having an acute problem. Please call the office as soon as possible so we can work our best effort to fit you into our schedule. At RARE times when there is a major illness outbreak in Fredericksburg we may have some patients who need to use urgent care facilities; but we make a strong commitment to you that 95% of the time we will be able to see you when you have an emergency. Keep in mind the best healthcare is continuity with the same provider so we strongly encourage our patients to see CIMA for all your care both urgent and primary care.
  2. What if I am running late, can I still come to my appointment?
    • We understand that arriving for your appointment late is sometimes out of your control. We will honor your appointment if you arrive within 15 minutes of your scheduled time. If you are later than 15 minutes after your appointment you may need to be rescheduled. We say “may” need to be rescheduled because if we can at all accommodate you we will try our best to see you but cannot guarantee this. We have this policy as we do not overbook our schedule and have time set aside for you, so being late eats into another’s appointment time and delays the physician having a snow ball effect for the rest of the day. To help us all stay on time please arrive 5 minutes before your appointment for an established patient and 20 minutes for a new patient.
  3. What if the physician is running behind, how am I treated and can I reschedule?
    • There are days when the physicians / PA are running behind schedule and we try hard to avoid this. Several factors go into creating this problem which are often beyond our control. Patients are late for their appointments, physicians are delayed dealing with critically ill patients in the hospital, and patients coming in with problems are more complicated than anticipated and may require more emergent time with the physician. We understand this seems like a “double standard” since the doctor can be late but we discourage you from being late for your appointment. Unfortunately when we deal with illness and patients who are in emergent need we can’t plan this into our schedule and openly understand its impact on you personally. We too have a schedule to keep and we assure you we make every effort to be reasonably on time, but our first priority is the best care for our patients. When we are more than 45 minutes behind schedule we understand patients may need to reschedule and staff will help you if this is really necessary.
  4. I understand there may be a penalty if I fail to show for my appointment, can you explain this?
    • If you fail to cancel your appointment with 24 hour notice to the office and fail to show for your appointment than you most likely will be charged a service fee. This is not to make revenue for the practice, we would much rather see you and tend to your needs; but this is a fee to deter discourteous patient behavior which causes holes in our schedule where other ill patients could have been seen but were turned away. Our practice strongly believes in your time and focusing on your needs when you are here so we do NOT overbook our time slots like many practices or other industries who anticipate a no show rate. To that end if a patient does not show up we have wasted time on our schedule in a busy practice that could have used this time for patients in need. In order to protect other sick patient’s access, which may be you one day, we have this “service fee” to discourage improper cancellation or failure to show for appointments.
  5. Do you give us copies of our labs if we ask?
    • We do give copies of your labs if you request them. We always call personally with lab results so we do not mail them to your home. As costs are a concern in health care we will generate a copy at no charge only if you request it when you are in the office. If you need copies of other labs and it requires chart retrieval and/or review there may be a very small copying charge. Also CIMA is launching in 2015 a secure patient portal to give you access to portions of your medical record allowing you to access them at any time.
  6. I need to have my medical records how can I get them copied and is there a fee?
    • We believe in access to your records and at times other physicians may need to see our records to assist in caring for you. There are two ways your medical records are copied. First, if CIMA is referring you to another physician or specialist for an illness to assist in your care than your records that pertain to the issue will be copied and sent for you to that physician’s office free of charge. The second way your records are duplicated is for your requested personal use or transferring out of the practice (i.e. moving to another state). We will copy all or part of your medical record (depending on what you ask us to prepare) that has been generated since your establishment with our practice. We cannot forward other physicians (historical records) records that were sent to our office PRIOR to your joining CIMA as this must come from their office. We do copy your records generated from your time with our practice upon your request for a fee that follows the Commonwealth of Virginia’s law pertaining to this service. We charge the nominal fees for the cost of the staff preparation time, paper, copying, and mailing of records for personal use. Please allow 2 weeks after we receive your signed written records request for processing of all medical records for personal use. Records from our Electronic Health Record (EHR) are burned to a CD-ROM in “.pdf” format to keep your cost down.
  7. What if I am hospitalized, who will care for me and how are you kept informed?
    • Medical care in the office is not the same as before as our physicians and PA’s are seeing in the outpatient setting more sick and complex cases that once were only seen in the hospital setting. Due to the increasing demand on our outpatient practice (where 98% of a patient’s care is given) and our patients now at three area hospitals it became impossible to round daily on our own patients in the hospital as we once did. Therefore, if you are admitted to any of our local hospitals our group utilizes “hospitalists” to care for you. A Hospitalist is an Internal Medicine physician just like our physicians that only specializes in hospital medicine. They have the same training as our physicians but due to the structure of today’s health care environment do not have outpatient offices and can better facilitate your efficient care in the hospital. They do not replace your primary doctor but in fact work in concert with us as they can discuss the case with your primary medical doctor if questions arise that need our input. Discharge summaries are sent to your primary physician at CIMA upon your release from the hospital to coordinate your follow up care from the hospital. Our physicians all maintain hospital privileges at all 3 area facilities and sit on hospital committees to ensure we are active and engaged in your care both in and out of the hospital.
  8. How do I get my prescriptions refilled?
    • We want to make refilling common long term prescriptions hassle free for you. If you are refilling a prescription that has run out of refills (look on your bottle and it will tell you if none are remaining) just contact your pharmacist and ask they fax a request to our office. Many pharmacies use “auto-fax” for your refills which cuts down on phone time and potential medical error when patients list their medication and dosage on a voice mail. We review your chart every time you call for a refill to review your case for accuracy. If there are questions or problems with your refill then staff will contact you directly or you may be given a one month refill and asked to make an appointment to see your doctor. Please give the staff 72 hours (3 days) notice for refill needs as it takes time to pull and review your records to generate the refill and doctors seeing patients won’t be interrupted to refill a prescription. We also use state-of-the art secure e-prescribing which allows your request to come in electronically from a pharmacy our patient portal (new in 2015) and sent out by our computer once authorized by the provider. Our patients have found this to work the best and most efficient for their refills.
  9. What is a “90 day supply” for prescriptions and how do I get one?
    • A “90 day supply” refers to a prescription that has 3 months’ worth in one bottle filled for you every 3 months and usually has 3 refills giving you 12 months of a prescription. Many patients, especially seniors, are encouraged by their insurance to get a 90 day supply of medication as they are often sent to drug clearing houses and in bulk can be cheaper for patients than just going monthly to the local drug store. How you go about a 90 day supply differs based on your insurance so call your carrier and ask which agency they use. Some insurers will allow you to go to your local drug store and get a bulk rate savings on a 90 day supply but you will need to check with them. If they do not allow this and you take a 90 day supply prescription to your local pharmacy they will charge you 3 co-pays instead of one. This all controlled by insurance and your individual costs will vary based on what company you are contracted with. When filling 90 day supply prescriptions please allow a 72 hour notice for CIMA to authorize the refill request. Many drug clearing houses need 2 weeks to receive and process your prescriptions in the mail. It can be a great savings but requires advanced planning on your part so know your insurance plans’ program and regulations before you file.
  10. What if I am on medication I cannot afford?
    • As medication cost rise some of our patients may encounter difficulty affording the pharmacy co-payment. Your physician has nothing to do with the cost of medication and receives no payment for any medication or treatment you receive so we are absolutely unbiased as to what medication is prescribed for you. CIMA physicians strive to select generic medication that cost the least and usually work the same as “brand name” drugs which can be costly in the form of higher drug co-pays. There are many drugs that have no generic because they are still on patent and insurance may charge you higher copayment to help cover the drug cost and/or act as a deterrent persuading you from taking that medication. If this is the best drug for you than discuss the cost issue with your CIMA physician who may be able to refer you to the “community pharmacy” that uses grant money to assist patients with affording their medications when finances are tight.
  11. I was told I am in the “Doughnut hole”, how can I get my medication cheaper?
    • The “doughnut hole” is a Medicare term that refers to a senior having to pay the full cost of their medication until they spend a certain dollar amount than at which time the government will resume paying the full cost of the patient’s medication. Many of you want to change medication to generic drugs during the “doughnut hole” period and go back on brand name medication when you are out of the hole. We understand this cost concern but CIMA physicians discourage patients from frequently switching their medication as generic and brand name medication do essentially the same thing but are not really the exact same drug at its chemical level. Sometimes insurance plans will tell a Medicare patient that a drug has a generic and to ask your doctor to change your medication. They are being a bit misleading in that the drug you are on has no available generic but a similar drug to the one you are taking has a generic (so it’s really the generic to a drug similar to your drug but not your drug’s generic). We will not do it over the phone, however, as this issue is complex and individual specific; changes to your medication may require monitoring so a face to face appointment with your physician is needed to safely change your medication if you and your CIMA provider deem appropriate.
  12. Is there a physician on call and do you see patients after hours?
    • Sometimes after-hour emergencies happen so CIMA always has a physician on-call 24 hours a day 365 days a year without exception. This physician is available for emergency calls only and will not be able to refill routine prescriptions, antibiotics or give lab results. They are on call for urgent medical concerns which can’t wait until the office reopens on regular business hours. If you are newly ill and have not been seen for this particular issue in the office you may be recommended by the on-call physician to be seen then they may suggest you utilize one of the many local urgent care facilities in the area and if needed follow up with your regular doctor during standard office hours. Most urgent care visits can be avoided and the office will make every effort to get you fit in each day we are open to avoid the higher cost urgent care visits and lack of continuity of care. To reach the on-call physician just call the office main line and follow the after-hours menu prompts.
  13. What can I expect from my first visit to the practice as a new patient?
    • Your initial visit will be about 35 minutes long. The physician/PA will review your current problem as well as an extensive history review and detailed physical exam. When you leave after your appointment we feel confident we know you well enough to have a good foundation to start as your new primary health care provider. We also feel confident you will have enough time to address your issue and set up a proper treatment plan on where to go from this initial contact with our office. Please bring a detailed list of your medications or all your pill bottles with you to your initial appointment. Your initial visit will also consist of a small orientation to our practice and your new physician so you leave our office not only well cared for but comfortable in your choice to establish with our group.

Section II

Financial Policies:

  1. Who is in charge of billing and how do we contact them if I have a question?
    • Our billing is contracted out to SA Medical of Virginia. They are a reputable family owned private medical billing company of which many private physicians’ offices utilize in our area. Should you have a billing question contact them at (540) 374-4488, or on the web at www.samedical.net. Should you still have unanswered questions please contact our office directly and speak with our front office supervisor who will be happy to assist you.
  2. How can I pay my balance?
    • We accept payment via mail to SA Medical or our office; and in person and by telephone. CIMA accepts cash, check, or major credit card and follows the new protocol set by the FTC for physician offices. We accept VISA, MasterCard, and Discover Card. Sorry but due to high fees we cannot accept American Express at this time. CIMA will accept your payment over the phone by VISA or MasterCard and we are developing a secure payment system for on-line payment. If mail and credit card is not your thing you are always welcome to come to one of our offices in person and our staff will be more than happy to assist you.
  3. Why is my co-payment due at the time of my office visit instead of just getting billed later?
    • Your co-pay for the services received on the date of service is actually contractually controlled by your insurance company. CIMA is obligated to collect this from you at the time of service as a partial payment for the visit. These regulations, as well as the amount collected, are stipulations from your private insurance company. It also serves a practical purpose as most insurance companies take 45 – 90 days to send payment to our office for services rendered; so your co-payment at the time services are preformed assists us in our base operations.
  4. What if I have a deductible, how is that addressed?
    • Deductibles are different from co-payments. This is the amount out of pocket that your insurance company states you must spend before it covers any of our services. We generally do not collect this at the time of your visit as we first bill your insurance company. After adjustments are made by your insurance a bill is sent to you for payment showing the amount the insurance has allowed us to charge you for the covered service and what amount is your responsibility. This is the final balance and what you send to CIMA. Please do NOT pay us based on an EOB (explanation of benefits) from your insurance company. We appreciate your kindness in remitting payment quickly but the EOB is not always correct. Please wait and remit payment per the CIMA Statement from SA Medical.
  5. Why do I get two statements, one from my insurance company and one from SA Medical?
    • In actuality you are only getting one billing statement. Insurance companies do not send billing statements for the practice. They will send you what is known as an E.O.B. (explanation of benefits) which lets you know as the insured that your company has received a bill from our office and what you may potentially owe to the practice. Do not pay CIMA based on the E.O.B from your insurance company. In some cases you may be paying too much. There are occasionally adjustments made and credits applied to your account that are reflected on your actual statement from SA Medical. Once you have received a statement from SA Medical that shows you the balance due than please remit payment for that amount to CIMA.
  6. If I paid a bill at the CIMA office but also received a statement in the mail with a balance still showing what should I do?
    • If you paid a balance at the office sometimes it is not posted to your account until 3-4 days later and may miss the statement period being mailed. If your statement does not reflect your payment it is always best to call the office or SA Medical and check on the payment posting to be on the safe side.
  7. I know I had been to the office and received services, but I have not received a statement, why?
    • There are a few reasons for this. There might be the situation where your insurance has been billed and we are waiting to hear back from them before a statement is mailed for your balance owed the practice. In the case of Medicare some claims can take several months to “clear” their office and it often delays SA Medical billing the patient so a statement may not come right away. Rarely the fault lies with the postal service or a faulty address. SA Medical mails all statements first class postage and if they are not deliverable they are returned to SA Medical. It is very important the CIMA office has the latest address on file for you to avoid this problem. SA Medical and CIMA investigate each returned statement and make an effort to contact you by phone to correct the delivery trouble and send out a duplicate statement; however if you have received services from our office and do not receive a bill in 30 – 45 days please contact our office or SA Medical to head off any trouble with your account.
  8. I did not receive a statement but the billing office says I am still responsible for the delinquent balance and must make a payment immediately; why is this?
    • SA Medical sends out three statements before your account is in trouble and delinquent. Each statement is 30 days apart. So in order to not receive a bill there would have been a failure to deliver the statement 3 times in 90 days – a problem only encountered if we do not have a current address on file. We consider it the responsibility of the patient to alert our office of address, phone, and insurance changes so we can properly bill your insurance company and the patient to make this hassle free for us all. Failure to receive a statement does not remove your obligation for clearing your balance; and not receiving a statement should cause you to contact SA Medical or our office to clear up the problem.
  9. What if my account is overdue and I am delinquent in clearing up my balance?
    • We understand the importance of your access to your doctors and not worrying about immediate payment; which is why we gladly give all patients a time period to pay outstanding balances. We are in this with you and want to give you the opportunity to quietly clear up existing balances with our front desk staff or SA Medical. If you have missed paying your balance and 3 billing cycles have passed you may get a concerned phone call from one of our staff to inquire if you are ok and if you are aware of the balance. Most of the balances are small and can be cleared up easily by contacting the office. It is only after this fails to resolve the issue that further collection action may be taken. This is rarely the case as our staff looks out for you and tries its best to notify you of any unsettled balance.
  10. I am on Medicare as my primary insurance, why do I have to pay a part of my bill?
    • Medicare patients usually pay nothing (no co-pay) at the office for a visit except their monthly premiums. That is not the case in the beginning of each year when each Medicare patient has a deductible, set by Medicare, to pay out-of-pocket before the insurance company starts to pay the full cost. This deductible is set each year by Medicare so please read your CIMA statement closely as even if you have Medicare you may have a balance for which you are responsible.
  11. I saw on my statement to contact my insurance as they did not cover any of my bills, can you explain why that might be?
    • When your insurance denies your claim in full they will give you a reason on your explanation of benefits (EOB). It may be, for example, that you have no insurance coverage for this particular problem; it was a preexisting condition; or your insurance has not responded at all to our office when we sent them the bill for services rendered to you. You can do two things to help clear up any insurance company confusion. First contact your insurance company and inquire as to why the particular service is not being covered or why they are not communicating with SA Medical over the bill. Second call our local outsourced billing company, SA Medical, and alert their staff you have called your insurance company and make a plan for resolving the issue. It is your responsibility to contact your insurance company and clear up any confusion they have so your bill can be properly billed. If this is not done then the full balance of the statement will be your responsibility.
  12. What if my insurance won’t cover a service?
    • For sure it can be difficult to know if a particular service is covered by insurance. We try to let you know trouble areas we see with insurance if we have a prior experience with patient coverage issues but it is our policy that the patient is ultimately responsible for knowing what services are covered. If you are unsure than call your insurance company and ask prior to receiving the service from our office. If you have a service for which your insurance company will not cover than you are responsible for payment of all fees for the services you sought out and received from our providers which your insurance will not cover.
  13. How long do I have to pay my balance?
    • Your balance, similar to other household bills you may have, is due within 30 days of the statement date. You can mail in your payment by check, phone in with a credit card, or come to the office and settle with cash, credit card, or check. If your balance goes unpaid than you will receive subsequent statements over another 60 days to clear this up. Staff may ask you to clear your prior balance when you come for another appointment and any balance over 60 days must be paid in full or a payment plan initiated.
  14. What does the office recommend I do if I am on hard times?
    • We know good people can fall on hard times through no fault of their own and we want to help you. First, our physicians spend 99% of their efforts and time on your health care not worrying about what you owe. Staff can assist you with a payment plan to get caught up with your overdue balance and keep you in a good relationship with our office so we can continue to concentrate on caring for you. As long as you are making payment plan payments and clearing up your balance we are happy to avoid any break in services or collection action from our office. Our office, like your work, needs to pay employees and other bills to stay open and keep CIMA around to take care of you when you need us. We can only do this when patients are being responsible for their balance obligations. Discuss your special needs with our staff and they will be happy to work something out with you.
  15. I did not show for an appointment and got charged a fee, can you explain why?
    • You were charged an office service fee for missing your appointment because you unfortunately had an appointment where you did not call to cancel in enough time for us to fill the slot (24 hours’ notice) or did not show for an appointment. We understand emergencies come up and you may need to cancel, and we take that into consideration; but we charge and enforce this service fee to discourage patients from causing this often avoidable situation. We have a busy practice and patients can go unseen when they are having an illness or emergency themselves because time was taken up with your appointment that went unfilled where other patients could have had access when they really needed it. Our office makes every effort to avoid this situation for you as we know life can get away from all of us at times and you can innocently forget about an appointment. To avoid this we give you written appointment cards and call 48 hours in advance of your appointment to remind you and, if needed, give you time to reschedule a visit with enough notice we can get other patients in need seen. Most of our patients respect and appreciate this service fee as we do not double book our calendar out of respect for our patients and your time so visits that are gone to waste can really impact the access to our office. Our fees for this are similar to those charged by almost all other professional offices and work well to keep access to our office available.
  16. Are there service charges for services not covered by my insurance company?
    • We often fill out quick forms or help you with a quick statement for your work or insurance free of charge. CIMA does charge nominal fees for certain services that require more time for the physicians themselves to sit down with your medical record, review your file, and render an official opinion. Please check with our secretary if your request will incur a service fee. Fees for services are commonly charged for FMLA documentation, disability forms, letters about your medical care/diagnosis to a lawyer or judge, medical letters needed to document your medical status and render an expert opinion, forms filled out separate from an office visit, and life insurance documentation. Our fees for these services are due when services are provided and not billed through our billing company. We have enjoyed great patient understanding of these fees in acknowledgement of the time it takes for our physicians to review and generate your requested documentation.

Section III

Professional Staff:

  1. Can you tell us about the background of the physicians and PA’s at CIMA?
    • Yes, please see the section of our website introducing a summary of the training and personal background of our providers.
  2. Can I see the PA instead of the physician?
    • Yes you can. As a patient of our practice you need to select which of our physicians is ultimately responsible for your overall care. Certainly many feel quite comfortable with our PAs and may wish to see them as their primary contact in our practice. All patients, however, are to see the physician on every 4th visit to CIMA so your physician can have a significant oversight role in your care and build their own relationship with you as well.
  3. What if I only want to see the physician instead of the PA, is that allowed?
    • Yes, although the physicians have trained and have total confidence in our physician assistant to care for your health care needs; we recognize there may be patients who feel more comfortable with the physician or have a problem they prefer to discuss directly with the doctor. It is always your right in our practice to see the physician for any problem. You may find that there is a slightly longer wait to see the doctor which is the trade off when not seeing the PA. Our main goal for our patients is for them to see the provider with which they feel the most comfortable.
  4. What exactly does Internal Medicine entail, and are there patients you do not see?
    • Internal Medicine is a primary care specialty that focuses on prevention of disease as well as chronic long term major illness management of adults. We start to see patients after they turn 16 and have a focus on adolescent medicine as well. We do not see pediatrics. There is a more detailed explanation of internal medicine on our website. Please follow this link to learn more about our critically important medical specialty.
  5. Do the physicians have any special focus or medical interests?
    • Yes! Our physicians, in addition to our main focus of internal medicine, have a focus on the special needs and medical care of adolescents and in women’s health. We also focus on your skin concerns and many procedures are done at CIMA to biopsy and treat suspicious skin moles and other conditions.
  6. Do you allow patients to switch their doctor in the practice?
    • As a general policy we do not allow patients to change physicians. We believe in continuity of care so we strongly encourage the same provider to see you as much as possible to continue your plan of care. At times, on a case by case basis, the practice will allow a patient to change which physician is ultimately the main doctor they will see in the practice so long as they are overall pleased with the practice and willing to see the other providers in the practice in the event they are covering for their regular doctor or there is an emergency. Keeping continuity of care is essential for primary care physicians to take care of your needs and build a healthy and trusting physician-patient relationship which gets to know you as a whole person, not just your individual illnesses.
  7. I am a new patient and coming for my initial visit to see the PA. I was told I need to also select a physician to be responsible for my care and was wondering how that works?
    • Our practice utilizes several excellent physician assistants who are perfectly capable of taking care of your immediate health care needs as well as helping follow up your care plan set by your physician. CIMA; however, recognizes a need for oversight in your treatment and in our view of practicing medicine a physician is ultimately responsible for your care in this practice. To help us with this we want all patients to understand that our practice views the care by our Physician Assistants to be a wonderful asset to our treatment team. We are serious about creating a culture in the practice where patients and physicians know one another even if a significant part of your care is provided by our PA. This is one of the essential differences with our practice patients enjoy and a critical difference in our practice culture where physicians, no matter if you saw them personally or not, are reviewing your care and treatment progress.
  8. Do the physicians and PA have any interests outside the office or services to the community?
    • Yes, our doctors and PA live in our community and have a vested interest in our town. They have small children and are active in little league and school organizations. Our physicians donate their time periodically to provide sports physicals that support school fundraising programs, and support local and national charities. Our providers maintain a relationship with the Moss Free Clinic and volunteer considerable time seeing less fortunate patients and providing health care free of charge. They maintain membership and are active with the Medical Society of Virginia, American College of Physicians, and American Academy of Family Physicians.
The mission of
Colonial Internal Medicine Associates is to set the local standard for treating illness in an empathetic and supportive environment. CIMA goes beyond the basic needs of patients in guiding them through complex medical problems as the patient's main health care professional, focus on the whole person with an emphasis on disease prevention, and take ownership of a patient's total medical care by serving as their chief advocate.
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