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FAQ

1. What Happens If I Miss My Appointment at GEM Neurology?

GEM Neurology No-Show and Cancellation Policy

GEM Neurology is a specialized outpatient neurology clinic with limited appointment availability. Missed appointments and late cancellations prevent other patients from using that appointment time.

Please review this policy carefully before scheduling your appointment.

Cancellation Policy

We require at least 24 business hours’ notice to cancel or reschedule an appointment.

You may cancel or reschedule by:

• Calling our office
• Sending a secure message through the patient portal
• Emailing us at info@gemneurology.com

If you cancel, postpone, or reschedule your appointment, you may be placed back on the waiting list. For new patients, the waiting list may be several months to over one year depending on availability.

New Patients

GEM Neurology is currently not accepting additional new patients due to limited physician and staffing capacity. This may change in the future depending on clinic availability.

A referral to GEM Neurology does not establish a physician-patient relationship. New patient appointments require a reserved appointment slot, usually 60 minutes. Because appointment availability is extremely limited, missed appointments and late cancellations may result in loss of the appointment opportunity.

If you miss your first new-patient appointment or cancel with less than 24 business hours’ notice, a $150 missed appointment / late cancellation fee may apply when permitted by law and payer rules.

This fee is not billed to insurance and must be paid out-of-pocket before another appointment is scheduled, if another appointment is available.

Rescheduling is not guaranteed. Because GEM Neurology is currently not accepting additional new patients, missed new-patient appointments may not be rescheduled.

If you miss a second new-patient appointment, you will not be rescheduled at GEM Neurology.

This policy will be communicated before your first appointment is scheduled.

TennCare / Medicaid Patients

TennCare, VA and Medicaid patients will not be charged a missed appointment or late cancellation fee when prohibited by law or payer rules.

However, missed appointments may still affect future scheduling availability. Because GEM Neurology is currently not accepting additional new patients, a missed new-patient appointment may not be rescheduled.

Established Patients

Established patients who miss 2 appointments within a 12-month period may no longer be scheduled for future appointments and may be discharged from GEM Neurology with appropriate written notice.

Established patients who accumulate 3 total no-shows, regardless of timeframe, may be discharged from GEM Neurology.

If discharge occurs, GEM Neurology will provide written notice and a 30-day transition period for urgent medication-related or neurologic issues while the patient establishes care with another clinician. Patients should contact their primary care clinician, insurance plan, or another neurology provider for continued care.

What Counts as a No-Show?

A no-show includes:

• Missing an appointment without notice
• Cancelling with less than 24 business hours’ notice
• Arriving too late to be seen for the scheduled appointment

An exception may be made for a documented emergency.

Emergency Exceptions

Emergency exceptions may include:

• Emergency room visit or hospitalization
• Motor vehicle accident or other serious accident
• Death or serious emergency involving an immediate family member
• Other documented medical emergency

Documentation may be requested.

Medical Emergencies

GEM Neurology is an outpatient specialty clinic and does not provide emergency care.

If you believe you are experiencing a medical emergency, call 911 or go to the nearest emergency department.

2. What Happens If I Am Late to My Appointment?

At GEM Neurology, we value every patient’s time and strive to maintain a smooth and efficient schedule.

  • Established Patients: If you are 10 minutes or more late, your appointment may need to be rescheduled.

  • New Patients: If you are 25 minutes or more late, your appointment may need to be rescheduled. Additional time is reserved for new patient visits to allow for a thorough evaluation.

  • If you are late without a legitimate reason, it will be considered a no-show and subject to the same policy as above.

We understand that unavoidable delays can happen. If you know you will be late, please notify us as soon as possible by phone at 865-666-4411 or email at info@gemneurology.com. We will do our best to accommodate you, but rescheduling may be necessary depending on the day’s schedule.

Exceptions for Emergencies

If your late arrival is due to a legitimate emergency or unavoidable circumstances, please inform our office immediately. We review each situation individually to ensure fairness and flexibility.

3. How do I request medication refills? 

Please request medication refills directly through our office or through the patient portal for non-urgent requests. In many cases, your prescription is written with enough refills to last until your next appointment, so please check your medication bottle first.

Please allow at least 48 business hours for routine prescription refill requests. Refill requests are processed during regular business hours only and are not guaranteed after hours, on weekends, or on holidays. Controlled substance refill requests require closer monitoring and should be requested at least 3 business days in advance. Additional review or an appointment may be required depending on the medication and clinical situation.

4. How do I request my medical records?

To request your medical records from GEM Neurology, please submit a written request to our office. For your privacy and protection, we may ask you to verify your identity before records are released. Patients may also be able to print available records directly through the patient portal. If you want your records sent to another person, physician, or facility, a signed authorization may be required.

Cost: Paper copies requested by the patient are $0.25 per page, plus actual postage if mailed. Records available through the patient portal may be accessed or printed there by the patient. All fees for patient-requested records are subject to applicable Tennessee and federal law.

5. What is a Medical Emergency?

A medical emergency is a serious health condition that requires immediate attention to prevent serious harm or potential risk to life. 
 
Here are examples of medical emergencies:
 
Severe Chest Pain
Especially if accompanied by shortness of breath, sweating, or nausea, as it may indicate a heart attack.

Difficulty Breathing
Includes severe asthma attacks, fluid in the lung, or allergic reactions.

Sudden Weakness or Numbness
Particularly on one side of the body, which may be a sign of a stroke.

Sudden Speech Disturbances
Difficulty speaking or understanding language may also indicate a stroke.

New, Severe sudden onset of Headache
A sudden, intense headache, especially if accompanied by vision changes, confusion, or nausea.

Falls with Head Trauma
Falls resulting in head injury with loss of consciousness, headache, or altered mental status.

Uncontrolled Bleeding
Bleeding that does not stop with pressure may need immediate care.

Loss of Consciousness (New Onset)
Any unexpected loss of consciousness should be treated as an emergency.

Acute or Sudden Altered Mental Status
Sudden confusion or disorientation may indicate a serious condition requiring urgent evaluation.

Seizure Emergencies:
• Impending Status Epilepticus: A seizure lasting more than 5 minutes.
• Multiple Seizures Without Full Recovery: Two or more seizures without regaining baseline awareness between episodes.

Severe Allergic Reactions
Signs include swelling of the face or throat, difficulty breathing, or rash (anaphylaxis).

Serious Injuries
Such as broken bones, deep wounds, or injuries to the head, neck, or spine.
 
If you or someone else experiences any of these symptoms, CALL 911 immediately or go to the nearest emergency room for medical care.
 
What are the Common Signs and Symptoms of an Acute Stroke?
 

6. How Do I Schedule an Appointment as a New Patient at GEM Neurology?

At GEM Neurology, a referral is required for all new patients, even if your insurance does not mandate one. This ensures we have the necessary information to determine if we are the right fit for your care. Self-pay patients do not require a referral.

Steps to Schedule an Appointment:

Obtain a Referral – Your referring physician’s office must complete and submit the referral form, which can be found in the upper right corner of our homepage (next to our office phone number). 

Submit Required Documents – Along with the referral form, your provider must include:

    1. A copy of your insurance card (unless self-pay).
    2. Face sheet from your medical records.
    3. Relevant imaging studies (e.g., MRI, CT, PET scans).
    4. Your most recent physician’s note.
    5. Prior neurologist’s notes, if applicable.
    6. Send Documents to GEM Neurology – Your provider’s office should fax these documents to 615-538-9421 or mail them to 155 Frank L Diggs Drive, Clinton, TN 37716.
  • Dr. Zayas personally reviews all medical records before scheduling to ensure we can provide the best possible care. 

Insurance & Payment Considerations

We strongly recommend contacting your insurance provider to verify your coverage before scheduling.

7.  What is the cost for a new or established patient visit if I don’t have medical insurance (Self-pay)?

For self-pay patients at GEM Neurology, the out-of-pocket costs are:
 
New Patient Visit: $399 (CPT 99205)
Established Patient Visit: $199 (CPT 99215)
Payment is required in advance when scheduling, whether the visit is in-person or via teleneurology.

Additional Information:

Financial Policy Agreement: The Financial Policy for Self-Pay Patients must be signed online or received in the office before scheduling an appointment. Click here to sign the Financial Policy Agreement.
 
No Referral Needed: Self-pay patients do not require a referral.
 
Click here to see the self-pay financial policy
Click here to see the Good Faith Estimate of Expected Charges - Self Pay Patients

8. What to Expect During My First Visit to GEM Neurology?

During your first visit to GEM Neurology, we aim to make your experience as comfortable and informative as possible. Here’s what you can expect:

Arrival: Please arrive at least 15 minutes before your scheduled appointment to allow time for check-in and any final paperwork.

Check-In: Our staff will confirm your personal and insurance information. If you’re a self-pay patient, we will verify payment details.

Initial Assessment: Your provider will review your medical history, discuss your current symptoms, and ask about previous treatments or medications to understand your health background fully.

Comprehensive Evaluation: A thorough neurological examination will be conducted, which may include tests of reflexes, coordination, balance, memory, and muscle strength.

Diagnosis and Discussion: Your provider will go over initial findings, potential diagnoses, and recommend any additional tests. Treatment options for symptom management will be discussed.

Treatment Planning: You and your provider will work together to create a personalized treatment plan, which may include medications, lifestyle recommendations, and follow-up scheduling.

Patient Portal Access: You’ll receive access to our Patient Portal for easy record review, appointment requests, and communication with our team.
 
Duration: The first appointment typically lasts around 1 hour.
 
If you have questions or need assistance before your visit, please contact us. We’re here to ensure you feel prepared for your care journey at GEM Neurology.

9. Do I need a referral to schedule an appointment at GEM Neurology?

YES. A referral is required to schedule an appointment at GEM Neurology unless self-paid. 

10. Do you charge for disability or FMLA paperwork?

Yes. GEM Neurology charges a $25 flat fee per set of disability or administrative forms. Insurance does not reimburse for this service, so it is the patient’s responsibility.

An appointment is not required if the necessary medical information is already documented in your chart.

The fee must be paid before completion, and please allow at least three (3) business days for processing.

Completion of forms does not guarantee approval of disability benefits, as final decisions are made by the employer or insurance carrier.

11. What methods of payment do you accept?

At GEM Neurology, we accept credit cards, debit cards, cash, personal checks, and bank checks. We do not accept money orders or MoneyGram.