|
Thank you for choosing ENT and Allergy Associates as your specialty provider. The following will assist you with understanding your financial responsibilities.
Upon check-in. Prior to the delivery of any care, all patients must complete a Billing Information Sheet and Medical History Form
that may be downloaded from our web site. Alternatively, we
can mail these forms to you prior to your scheduled visit so that you may complete them at home. Our sign-in sheet includes a variety of authorizations and approvals regarding the accuracy of the information on the forms you have supplied. Signing in at the office means that you have read our forms and policies and allows us to share your information with our billing company and the persons you have indicated who can discuss your information according to HIPAA regulations. After signing in, please present your insurance card(s) and written referral when required by your managed care plan. Your cooperation will facilitate processing of your claim.
Participating providers.
The physicians at ENT and Allergy Associates participate in many managed care plans,
but not all. It remains your responsibility to verify that the plan includes
the physician you are scheduled to see and that you have a valid referral if
your plan requires one.
Co-payments, co-insurance, and deductibles. Health insurance and managed care plans have evolved into a myriad of products, many of which include patient responsibility for a portion of the cost of care provided. Co-payments are that amount that your policy requires us to collect with each office visit. Co-insurance is that percentage of the bill that is your financial responsibility. Deductible is the total amount that your policy requires you to pay before they will pay claims on your behalf. We will try to identify for you that portion for which you are responsible at the time of your visit. It is our policy to collect these amounts at the time services are rendered.
Office procedures. Please be aware that certain procedures
performed in our office are not included in the standard office visit.
These procedures will be billed separately and in addition to office visit
charges. We have become aware that some carriers are classifying these
procedures as "surgery" and applying the charges to a higher deductible amount.
The result may be insurance payment for an office visit but not a procedure, and
in such case, payment for the procedure will be due from the patient.
Please be assured that we are following accepted billing and coding guidelines
and that all procedures are performed in the best interest of patient care.
Examples of in-office procedures include: flexible laryngoscopy (to look through
the nose at the back of the throat and voice box), nasal endoscopy (to look at
the sinus openings and nasopharynx), and nasal endoscopy and debridement (to
remove nasal or sinus crusts, scar tissue, or polyps using endoscopes).
Non-covered services. Non-covered services are those that your plan does not include in your benefit package. Often, this is defined clearly by your plan, e.g., cosmetic surgery. When identified, payment for such services may be collected when the service is scheduled.
Plans with which we do not participate. If you have an indemnity insurance policy or are using your out-of-network option within your managed care plan, we will be happy to submit your bill on your behalf.
We are committed to
providing the highest level of care to our patients. You are responsible
for payment regardless of any insurance company's arbitrary determination of
reasonable and customary rates.
The responsibility for payment for the services rendered remains yours, and you will be receiving statements from us to that effect. If the carrier should direct payment to you, your immediate remittance and a copy of the carrier's explanation of benefits will be expected. If your health plan delays payment beyond 60 days we will transfer the balance to your personal responsibility. Under such circumstances, we will support your efforts to receive proper reimbursement from your plan.
Self-pay. If we will not be submitting insurance charges on your behalf, our fees will be based upon time spent rather than the specific services we provide. We find this to be very fair and predictable for our patients without health insurance or for those patients who do not want to use their insurance benefit for our services. Payments are due at the time the service is rendered.
Worker's Compensation and Personal Injury.
All Worker's Compensation and Personal Injury/Auto
cases must be reported at the time of the first visit. Case numbers, claim
forms, and filing addresses are required at that time, including any attorney
names, addresses and telephone numbers. Without that information, services
rendered will be applied to health insurance in accordance with the other
sections of this policy statement.
We will supply office notes and narratives on your behalf when asked.
Missed
Appointments. Please
help us serve you better by keeping scheduled appointments. If you do not
believe that you can attend a scheduled appointment, please call us to cancel at
least 24 hours in advance. There is a service fee for missed appointments.
Surgery Booking Deposit. Whenever a surgical procedure is scheduled, significant administrative efforts are expended to meet Health Plan requirements as well as hospital or surgery center regulations. Furthermore, significant professional time is reserved for the procedure including all care given before, during and after the operation. If you elect to have surgery, a five hundred dollar
($500.00) surgery booking deposit may be collected at the time that you schedule your surgery. This deposit is refunded to you on the day of your surgery. If you cancel or postpone the surgery and give notice at least three weeks prior to the scheduled procedure, the deposit will be fully refunded. In the absence of extenuating circumstances, the deposit will not be returned if the surgery is canceled or postponed with less than three weeks notice.
Interest. Any unpaid balances due 60 days after the date of service will accrue interest at a rate of 1.5% per month.
Payment. We accept cash, personal checks, VISA and MasterCard.
|
