ear, nose, & throat associates   of corpus christi

 

 

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Financial Policy

Office Visits

We make every effort to keep down the cost of your medical care. Because the billing process has become so expensive and because we all wish to keep medical costs as low as possible, PLEASE PAY FOR OFFICE VISITS, X-RAYS, HEARING TESTS, ETC. AT THE TIME THE SERVICE IS RECEIVED. Patients with Medicare, Medicaid, or Managed Care pay in accordance with the laws or contracts governing those plans. It is the patient's responsibility to bring to our office his/her insurance card and insurance information.

After you have been seen by your doctor, you will be given what most doctors' offices call a "Superbill" (Charge Ticket) to take to the CHECK-OUT desk. The doctor uses the Superbill to document the services and procedures he has performed for you. The person at the CHECK-OUT desk will compute your bill and request payment. The pink copy of the Superbill is your receipt for payment.

It will also provide verification for extended benefits. The yellow copy may be used to file your own health insurance claims. A doctor's signature is not required, as the completed form is sufficient. If requested, we will complete an insurance claim and file it unassigned on your behalf, so that any amounts paid will be mailed directly to you.

Surgery, CT Scans, ENG's, and Allergy Testing

Services requiring larger fees can impose a burden on the financial resources of most people. Therefore, we do accept insurance assignments for these services provided you give us complete, accurate insurance information and we are able to verify your coverage before services are provided. Our Pre-Certification personnel will help you to take care of this.

While we are happy to help you receive the maximum benefits allowed by your insurance carrier, bear in mind that it is your responsibility to pay as a deposit any deductible amount, coinsurance or any other balance not paid by your insurance company, prior to receiving services. Even though we assist you in receiving reimbursement from your insurance company, please understand that you, the patient, ultimately have the final responsibility for your bill.

 

Liability and Workers' Compensation

We do not accept assignment in the case of liability actions. A liability action against someone else is not a reason for delaying payment of your bill. Payment of the bill is the responsibility of the person receiving treatment, not the person being sued who may or may not win the litigation. For these reasons and because lawsuits are often protracted (3 to 5 years), we ask that our bill be paid promptly. We will, of course, furnish your attorney with your medical record provided a signed release accompanies your request.

In order for us to accept assignment of workers' compensation insurance, the patient must bring a written acceptance of financial responsibility from his/her employer or the employer's workers' compensation carrier. However, the patient is still responsible for the bill if the insurance carrier does not pay within 60 days.

If you have any questions about our FINANCIAL POLICY or your health care insurance, please call our Business Office at (361) 854-8843.

Medicare

We accept assignment on Medicare claims. Medicare patients will be required to show proof that they have met their deductible for the year, and to pay their 20% portion at the time of the visit.

Managed Care, HMO's and PPO's

In addition to the traditional insurance carriers, and Medicare and Medicaid, we are contracted with several Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). Because each plan is different, refer to your insurance handbook for specific requirements for office visits or surgical procedures. As a rule both HMO's and PPO's require you to pay a "co-pay" usually $10.00 to $20.00, each time you visit a doctor.

HMO's require you to select a primary care physician (PCP). You must go to your PCP for all your medical care. Only your PCP can refer you to one of our doctors. When this happens, you will need to bring your referral documents with you when you come to our office.

PPO's require you to see only physicians who are contracted with the PPO. Most PPO's put out a Provider Directory to tell you who those physicians are. If you are uncertain about a physicians participation, call that doctor and ask if he/she participates in your PPO. You can visit any doctor that participates in your PPO without prior approval. Some procedures and most surgeries require that PPO's approval, but we will help you to obtain that authorization when we know what treatment you require. Patients in PPO's should bring proof of having met their deductible.

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