DALTON EAR, NOSE AND THROAT FINANCIAL POLICY
Thank you for choosing our practice! We believe that establishing a written financial policy is mutually beneficial for all parties. It is our goal to avoid any mis-communication or concerns regarding financial matters in order to focus our energies on providing healthcare services to our patients. Our staff is available to assist you should you have any questions. Our financial policy is as follows:
All Payments are expected at the time of service. This includes, co-payments, co-Insurance and deductibles. (Co-payments, deductibles, and co-insurance are expected during the check in registration)
- Insurance Card – Please provide a copy of your insurance card prior to each visit.
- Insurance Claims -We will file insurance for you under most circumstances as long as you provide us with current information on your insurance plan. Each plan has different benefits for you as well as different financial obligations. Not all insurance policies cover all services. You are ultimately responsible for understanding the details of any particular coverage you may have as well as the payment of all charges you incur.
- Unpaid Insurance Claims -If your insurance company has not responded to us within 60 days of a filed insurance claim, the charges will be sent to you directly and you will be responsible for their payment as well as for payment of any other charges incurred consistent with this financial policy.
- Authorizations – If your insurance company requires referral authorization from your primary care provider, it is your responsibility to obtain this information and provide it to Dalton ENT before services are provided.
Minor Children Patients
- Responsible Party -It is recommended that a parent or legal guardian accompany patients who are minors and for new patients the legal guardian must be present. Surgeries and or procedures cannot be scheduled without t legal guardian present.
- Charges -Charges for services rendered to minor children are the responsibility of the parent who seeks treatment for the child and are due at the time of service.
- Minor Children of Divorced Parents -Payments, co-pays, co-insurance and deductibles are due at the time of service from the parent who seeks treatment for the child regardless of any court-ordered responsibility for medical costs.
- Financial Responsibility of Both Parents – The stated terms of this Financial Policy shall not modify the duty of both parents to provide for the welfare of their minor children. We expressly reserve the right to hold either or both parents responsible for any and all reasonable and necessary medical expenses.
Self-Pay Patient Discounts
We offer a discount to our self-pay patients when payment is satisfied at the time of service. Self-Pay Patient Discounts do not apply to co-pays, co-insurance, deductibles, non-covered services in some instances, and medical supplies. Deviations from, and exceptions to the eligibility criteria set forth in this policy must be approved by the Administrator.
Self-Pay Patient Deposits
We may collect deposits for office visits and/or other services as necessary prior to services being rendered. For self-pay patients we will collect $200.00 in advance of providing services for office visits and procedures. Any surgery procedures we require half of the surgery fee in advance.
Surgery DepositsWe collect a deposit of $250.00 to hold your surgery date. In the event that do not provide us 72 business hours advance notice (Monday – Friday at noon) you will forfeit your deposit. If you keep your scheduled surgery date the $250.00 will be applied towards deductible and/or co-insurance or be refunded back to you after your insurance had paid.
No Professional Courtesy Discounts
It is our policy not to extend professional courtesy discounts.
Old balances on your account must be paid in full prior to receiving additional routine services. Please contact us if you are unable to pay an old balance or if you have questions.
Missed Appointment Charge
If you fail to keep a scheduled appointment/procedure and do not give our office at least 24 business hours advance notice of cancellation, you may not be allowed to schedule future appointments and will be charged a $35 no show fee and will be seen on a work in basis only. Patient who have 3 “No Shows” without calling us 24 hours in advance will be dismissed from the practice.
Additional Service Charges
Returned checks are electronically recovered through Checxchange. Should your check be returned for insufficient funds, you expressly authorize your account to be electronically debited or bank drafted for the amount of the check plus any applicable fees. The use of a check is your acknowledgement and acceptance of this policy and its terms and conditions.
Collection Costs, Court Costs, and Attorney Fees
Accounts may be turned over to a third party for collection service, if past due 90 days or more.
If we have to reschedule your appointment three times and you have not provided us with 48 business hours’ notice, you may be discharge from the practice.
Our Patient Care Services
- Relief for Ear, Nose, Throat & Hearing Problems
- Nasal and Sinus Treatment
- Balloon Sinuplasty
- Allergy Care & Management
- Comprehensive Pediatric ENT Care
- Sleep Apnea Diagnosis & Treatment
- CT Scanning Services for Head & Neck
- Hearing Problems, Diagnostic Testing & Hearing Aid Fitting
- Chronic Cough
- Ear Pain & Infection
- Skin Lesion & Cancer Removal
- Balance & Vestibular Disorders
- Head & Neck Masses
- Thyroid & Parathyroid Problems
- Nose & Ear Cosmetic Care