Billing Policies and Procedures
Managed Care places specific responsibilities on Physicians and Patients. These responsibilities are spelled out in the contract with the insurance carrier. Understanding your role will help facilitate referrals and financial matters. We hope you will take a few minutes to familiarize yourself with our Office Policy regarding finances and referrals.
It is the patients responsibility to ensure that a valid referral is on file for the services being rendered. Referrals are usually good for 30 to 60 days depending on the carrier and in the cases of Allergy shots, some carriers will allow a global referral (up to 1 year).
Please be courteous to the Primary Care Physicians (PCP) and request the referral early as some of the offices require 3 to 7 days of advance notice. The patient may need to pick up the original referral from the PCP, however, in some cases the PCP is willing to fax the referral to our office. We do accept faxed referrals.
- Office charges are due and payable at the time of service. Our Billing Office is to help facilitate insurance claims and questions you may have. Accounts past 30 days old are considered delinquent and those at 90 days will be referred to a collection agency for action.
- Professional services are rendered to the patient not an insurance company. Since every insurance plan is different, please be sure to check your coverage and ask questions before services are rendered. We are here to help in any way we can.
- Your insurance can deny payment for services or procedures after they are performed. We advise that you know the benefits of your individual plan.
- Payment may be made by cash, check, Visa, MasterCard, Discover, and Care Credit.
- The office participates in a variety of health insurance programs. If you are a participant in an insurance program that we accept, you are expected to pay your co-payment at each visit. Failure to do so can result in action by your insurance carrier. Managed Care patients are liable for co-payments, per their carrier, and for appointments not canceled in advance.
- The Billing Office files claims for all carriers with whom we participate. Payments by the insurance carriers will be made directly to our office. They will provide you with an Explanation of Benefits (EOB) of the charges, amount covered by your policy, and payments made to our office on your behalf. Your insurance may or may not allow a portion of your bill, the remaining balance is your responsibility. If you have a secondary plan, as a courtesy, the billing office will submit the primary payment information to the secondary carrier. We will file your primary and secondary insurance only unless a third insurance is Medicare.
- The Billing Office submits all Medicare claims for you. We also provide Medicare with your secondary insurance information. Through their crossover program, your secondary insurance will be billed directly by Medicare. Please check to see if your secondary insurance requires a signed waiver in order for this to happen. Our office will bill insurances not included in the crossover program. You are responsible for yearly deductibles, non-covered services, and co-payments when there is no secondary insurance.
- As a courtesy, the Billing Office also files claims to carriers with whom we do not participate. Payments by the insurance carriers may be sent directly to the patient instead of our office. It is the responsibility of the patient to remit payment to our office at the time of service in these cases. If you have a secondary plan, as a courtesy, the billing office will submit the primary payment information to the secondary carrier.
- Self-pay patients are given a courtesy discount if they pay the entire amount due at the time of service. We understand that this is may not be possible in every case. When necessary, a Payment Plan for the full amount can be arranged in advance by calling the Billing Department at (901) 761-0600 to make arrangements. A Promissory Note will be required the day of the visit prior to seeing the doctor.
- Workman’s Compensation is filed as a courtesy to our patients. However, if a claim is denied, unsettled or unpaid within 60 days, we request that you file a personal claim and pay the bill in full. In all legal matters you are responsible for payment.
- Special consideration will be given to patients financially unable to pay in full at the time of service. Arrangements should be made in advance with the Billing Office.
- There will be a $35.00 charge for all returned checks.
Thank you for choosing Ear, Nose & Throat Group, Inc. as your Healthcare Provider.