Ear, Nose, & Throat Centers of North Texas Financial Policy
Thank you for choosing Ear, Nose, & Throat (ENT) Centers of North Texas as you health care provider. We are committed to providing excellent health care services to you, our patient. As a part of our professional relationship, it is important that you have an understanding of our financial policy.
All patients will be given a paper form of this policy, they must sign a form acknowledging they they have reviewed and understand policy prior to receiving services.
1. It is your responsibility to provide us with your most current insurance information.
2. If you fail to provide accurate insurance information in a timely manner, your insurance company may deny the claim. If the claim is denied, you will be financially responsible for services rendered.
3. We must emphasize that, as medical providers, our relationship is with you, the patient, and not your insurance company. Your insurance is a contract between you, your insurance company, and possibly your employer. It is your responsibility to know and understand the level of services covered by your insurance company.
4. Please be aware that some or perhaps all of the services provided may not be covered in full by your insurance company.
5. Before receiving services, you must verify that we are participating providers for your insurance company. It is also necessary that if a primary care physician must be listed with your insurance company, you are responsible for obtaining and maintaining a current referral to the doctor you are seeing from the physician listed with your insurance. Without a current referral payment must be made in full at the time services are rendered for the total amount charged.
6. We charge what is usual and customary for our area. You are responsible for payment regardless of any insurance company’s arbitrary determination of usual and customary rates.
7. Co-payments, coinsurances (%’s) and/or deductibles are due at the time of service. We will estimate the amount you owe based on information we receive from your insurance company. However, you are responsible for paying the full amount determined by your insurance company once they have paid your claim—regardless of our estimation.
Regarding Patient Billing:
1. It is your responsibility to provide us with your most current billing information
2. You must provide your most current billing address, all available telephone numbers and any other important contact information. If your address or contact information changes, it is your responsibility to contact us with the updated information.
3. We will send a statement (to the billing address you provide) notifying you of any balances you may owe. If you have any questions or dispute the validity of this balance, it is your responsibility to contact our business office within 30 days after receipt of your first statement. You may call (903) 771-7503.
4. Payment is due upon receipt of the first statement. If payment is not received in a timely manner your account may be referred to a professional collection agency and/or attorney for further collection activity.
5. If you are not able to pay the balance in full, you may contact our billing office to discuss a mutually agreed upon payment arrangement at (903) 771-7503.
6. If your account is assigned to a professional collection agency you will be notified by mail that you will no longer be able to receive services from any of the physicians at our office. Failure to accept this letter (and/or pick it up at the post office) serves as termination of services.
7. In the event that you submit payment by check and the bank returns the check for any reason, we will add $35.00 to your original balance. In addition we may seek all legal remedies provided to us under Texas law.
8. We may charge you a “No Show” fee of $25.00 if you fail to cancel or reschedule your appointment. (please see our complete NO SHOW POLICY for furtherexplanation)
9. Failure to keep your account balance current may require us to cancel or reschedule your appointment!
10. Full payment is due at time of service. We accept cash, check, and credit cards. At this time we can take Visa, Mastercard, and Discover. Our online payment portal can accept American Express through Paypal.
Responsible Party for Minors (18 years and under)
We assign all financial responsibility to the parent /guardian that completes and signs the patient registration form. Any amount due at the time of service is expected from the parent /guardian accompanying the minor at the visit. In the event that a divorce decree assigns distinct financial responsibility for medical bills to another individual, we still hold the registering parent /guardian responsible. We will provide you with receipts showing payment to assist you in the recovery of such payment, however we do not get involved in separation/divorce disputes.