Billing Policy

To Our Patients

Managed Care places specific responsibilities on both Physicians and Patients, which are clearly defined in the contract with the insurance carrier. Understanding your role will help facilitate referrals and financial matters. Please take a few minutes to familiarize yourself with our Billing Policy regarding finances and referrals.

Pre-Existing Conditions

Please be aware that patient's being seen by the Physician for a pre-existing condition, may not have insurance coverage for that condition if they are using a new insurance policy. The services received may be considered a covered benefit, however, if a pre-existing clause is in effect, the insurance carrier may choose to make that physician visit a self-pay visit, even after the services have been verified with the insurance company. It is the patient's responsibility to know their insurance policy. You will receive a bill from our office if your insurance carrier, due to a pre-existing clause, denies payment.

Referral Policy

It is the patient's responsibility to ensure that a valid referral is on file for the services being rendered. Referrals are valid for specific time frames depending upon your insurance contract and carrier. In some cases, such as allergy shots, some carriers will allow a global referral period. If you do not have a referral on file with our office at the time of your scheduled appointment, you will be required to pay out of pocket for your physician's visit or reschedule for another day.

Please be courteous to your Primary Care Physician (PCP) and request the referral early. Some PCP offices require up to a week of advance notice. The patient may either pick up the original referral from the PCP, or have it faxed directly to our office.

Financial Policy

Our Billing Office will help facilitate insurance claims and answer questions you may have. We are here to help in any way we can.

Office charges are due and payable at the time of service.

These charges include co-payments, co-insurance and insurance deductibles. Accounts 60-days old are considered delinquent and those at 90 days will be reviewed for action. Payment may be made by cash, check, Visa, or MasterCard.

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.

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 denial could be due to a pre-existing condition clause in your coverage. Also, be aware that we are a specialist's office and some procedures that are performed during your visit may be considered "additional" procedures outside of the traditional office visit. Your insurance company may interpret these procedures as "surgical procedures" or "medical procedures" and you might be required to pay a different deductible or co-payment.

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 office charges. The remaining balance is your responsibility. If you have a secondary plan, and it is a plan with which our office participates, the billing office will submit the primary payment information to the secondary carrier as a courtesy.

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 if they are plans with which we participate. You are responsible for yearly deductibles, non-covered services, and co-payments when there is no secondary insurance.

Payment of services is due at the time of your visit.

The Billing Office will assist you with submitting claims to those insurance carriers with whom we may not participate, however, you will be held responsible for paying those charges and submitting the claim on your own. Payments by these insurance carriers for the office visit, office procedure, etc. should be sent directly to the patient instead of our office.

Special consideration may be given to patients financially unable to pay in full at the time of service. Arrangements may be made in advance with the Billing Office.

There will be a $25.00 charge for all returned checks and another form of payment will be expected to cover your portion I understand and agree to be responsible for any portion of this claim that, for any reason, is not covered by my insurance. I further understand and agree to be responsible for (1) a $20 missed appointment fee, if a 24 hour cancellation notice is not given to Maryland Ear, Nose & Throat, LLC, (2) A $100 fee for any scheduled surgical procedure which is cancelled without notice or within less than one week's notice from the date of surgery, (3) A $20 fee for any returned check.