This Financial Policy is designed so patients and/or parents/guardians of Ear, Nose and Throat, Ltd. understand our position on payment for services rendered by the providers.
- All new patients will be required to fill out an Ear, Nose and Throat, Ltd. Patient Information Sheet, front and back.
- The back of the form contains an explanation of financial expectations for patients and/or parents/guardians for services rendered by the clinical providers at ENT, Ltd.
- The patient will read and sign the back of the form. The Receptionists will witness the form with their signature and date it.
- The front and back of the form will be scanned into the Electronic Medical Records of the patient. The original is placed in a locked shredding bin.
For Self-Pay Patients
- A standardized payment formula will be used for office visits and procedures conducted in the office. A minimum of $150 is expected prior to seeing the doctor. A pre established standard deduction will be applied by Ear, Nose and Throat, Ltd. to the office visit / procedure charge.
- Once the patient’s visit is concluded, the check out personnel will review the Superbill, if there are additional procedures marked, to include Audio, the patient will be informed that additional charges have been incurred and will be billed to the patient. It is not the front desks responsibility to inform the patient of the amount, this will be calculated by the Billing department within approximately 14 business days of the visit.
- For patients that did not have any other procedures or Audio, the patient may be eligible for a refund, but this will not be confirmed until after the Superbill has gone through Billing, in approximately 14 business days.
- When surgery is required, in most cases, a 50% down payment is expected at least one week prior to the elective surgery date. The remainder of the payments will be expected within 30 days after the surgery, unless other payment arrangements are made.
- For urgent surgeries, the Patient Account Representative from Ear, Nose and Throat, Ltd. will work closely with the patient to establish a payment plan.
- For special cosmetic cases, these will be handled on a case-by-case basis and are discussed between the patient and the doctor.
- Patient accounts are considered delinquent if no payment has been received within 30 days after the mailing of the second invoice, unless the patient has contacted the Patient Account Representative.
- These delinquent accounts are sent to the pre-collections department where attempts will be made to collect the monies owed.
- If after 60 days, no monies have been received, then the account is forwarded to a collection agency
- A finance charge will added to the account at that time in the amount of 15% of the amount owed. Accounts with a payment plan will be excluded.
- The patient is expected to pay the balance and all reasonable fees associated with the account being in pre-collections and collections.
- By signing the back of the Patient Information sheet the patient, parent/guardian acknowledge that this form is being signed in either Norfolk, VA, or Chesapeake, VA, and that services are being performed in either Norfolk, VA, or Chesapeake, VA and should a suit become necessary to collect on this account that court filings will be in either Norfolk, VA or Chesapeake, VA.