Texas Ear, Nose & Throat Specialists, LLP - Bedford, Grapevine and Southlake, TX

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, therefore all payments are due at the time of service. We request your insurance information prior to the visit to verify your benefits before the appointment. This is done as a courtesy, and is not required. We do collect all copays and toward deductible and co-insurance, if applicable, at check-in. We do collect a $135 self-pay fee at check-in for new patients and $95 self-pay fee at check-in for established patients. This fee is a deposit for the visit and may not the total amount due. If there are any additional fees or remaining balances based on services rendered during the appointment, we will collect at the end of the visit.

Patients with Medicare 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. If your insurance requires a referral authorization to be seen, it is your responsibility to ensure we have received that referral. If you do not have a referral on file, and you wish to be seen, you will be responsible for the fees not covered by your insurance at that visit.

Surgery, ENGs, Allergy Testing, In-Office Imaging

Services requiring larger fees can impose a burden on the financial resources of many 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. We also will often require a deposit before surgery, and may require payment to hold your surgery date. 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. If you have no insurance and need help paying for your services, our Business Office personnel will help you to work out an agreeable payment program.

Insurance Coverage

While we make a good faith effort to verify your coverage, we are not liable to guarantee that the information given to us by your insurance is correct. It is your responsibility to know what services may or may not be covered by your insurance. We encourage you to refer to your benefits manual if you have any questions about covered services and work with us to make sure that these services are provided at the most cost-efficient manner. It is also the patient’s responsibility to notify the office of any changes to insurance to update the assignment of benefits. Finally, in the event that insurance information you provide delays payment, you will be asked to pay in full billed charges and seek reimbursement from your insurance provider directly. The insurance company gives us a very small window in which to file a claim, and incorrect insurance information usually delays this beyond their window.

Liability Actions, Third Party Payers

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.

If you have any questions about our FINANCIAL POLICY or your health care insurance, please call our Business Office at 817- 540-3121.

Outstanding Balance

If you have a balance on your account, we will send you a monthly statement, this is available via the patient portal and we will also issue paper statements. If your account becomes past due, we will take the necessary steps to collect this debt. If you are unable to pay in full, you can contact our billing office to determine if a payment plan is available. Failure to make scheduled payments on the payment plan or not paying off a balance in full may result in your account being turned over to a collection agency. If we must refer your account to a collection agency, you agree to pay all collection costs that are incurred. All accounts sent to the collection agency will be reported to the Credit Bureau. If there becomes a need to send the balance of an account to a collection agency due to non-payment of the account, the physicians of Texas Ear, Nose & Throat Specialists, LLP will no longer be able to provide care. In this case, the patient will receive written notification and given adequate time to find a new health care physician. If your account is sent to collections and then paid in full, the patient may request the practice reinstate the account. If the practice permits reinstatement, the practice may charge a $25 reinstatement fee which is not billable to insurance. The fee must be paid prior to scheduling any future appointments. Waiver of Confidentiality: You understand if the account is submitted to a collection agency or if your past due status is reported to a credit reporting agency, the fact that you received treatment at our office may become a matter of public record.

Fees for Forms

Any paperwork to be completed by the physician or physician delegate at the request of the patient can generate a fee which is not covered by insurance. Payment is due at the time forms are dropped off, and is to be collected prior to completion.
FMLA forms- $25.00 per set of forms
Disability forms- $75.00 per set of forms
All other form requests- $10.00 per set of forms

Medical Records

Medical records are handled through an outsourced 3rd party. Please contact Vital Chart at 972-399-0914 to request copies of your records. You can also, contact them directly at www.vitalrecordscontrol.com. Click Request Medical Records.
For CT scans done in office, please contact 817-540-3121 to request a copy. There is a $25 fee for the CT scan disc.
Please note that we have up to 15 days to complete records requests in the State of Texas.

If you have any questions about our FINANCIAL POLICY, please call our Business Office at 817-540-3121. If you have questions regarding your insurance benefits or network providers, please contact your insurance carrier directly.

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