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Midwest Ear, Nose & Throat Financial Policy
General Billing Information
Midwest Ear, Nose & Throat appreciates the opportunity to provide high quality care to our patients at a reasonable cost. To assure continued care in the community, we have developed the following financial policies.
Our billing department is more than happy to assist patients with any questions they may have regarding their bill or upcoming services. The billing department can be reached by the following methods Monday thru Friday 8:00 AM- 4:00 PM:
Phone- (309) 691-6616
Payments can be made using cash, check, money order, or credit card. We currently accept Visa, Discover and MasterCard. All patients are required to make any patient responsible portion at the time of service. If payment is not made, we reserve the right to reschedule your appointment.
Midwest Ear, Nose & Throat requests that you familiarize yourself with your health insurance policy and know your co-pay, deductible, co-insurance and policy benefits before your appointment. Your insurance is a contract between you and your carrier. We will assist you in receiving appropriate reimbursement from your carrier; however, payment is ultimately your responsibility. You may be required to make payment at the time of service depending upon your insurance plan. All co-pay, co-insurance and deductible amounts may be payable at the time of service.
An insurance card must be presented at your first visit to ensure proper billing. You may be asked to present this card for verification purposes at subsequent visits. If you do not have your card and we cannot verify benefits, you may be asked to reschedule your appointment or will be considered self-pay in which payment for services will be required at the time of service, until a valid copy of the insurance card is provided to us.
While we accept all health insurance plans; it is the patient’s responsibility to contact their insurance carrier to verify that the specific physician or provider with Midwest Ear, Nose & Throat is contracted with them. If a referral is required by your insurance plan, it is your responsibility to contact your primary care physician before your appointment.
We will bill your services to the appropriate primary and secondary insurance carrier. If they fail to respond to our claim, you will receive a statement for charges. Statements are sent monthly and payment is due within 30 days.
Patients with insurance from a non-contracted carrier (out of network) will be responsible for any co-insurance, over usual and customary or unpaid balances. There are times that our practice allows benefit-matches; however, this does require approval prior to services being provided and are determined on a case-by-case basis. If your insurance company indicates a charge is above usual and customary, please understand that this means it is above their allowable rate. We believe the fees for our services are fair and reasonable. They are based upon national and local studies of fees for similar services and are updated annually. Questions related to usual and customary should be directed to your insurance carrier.
Uninsured Patients (Self-Pay)
If you are not covered by a health insurance policy you will be considered self-pay. This requires that new patients pay a minimum of $175 at their first visit and a minimum of $120 at any subsequent visit. This is a deposit on services rendered and any balance over the deposit will be billed to you. We do offer self-pay discounts and your discount will be applied once the charges for your visit are entered. Please speak to our billing department regarding any questions regarding self-pay discounts.
Department of Health and Family Service (Illinois Public Aid, KidCare, & Commercial IDPA Plans)
A primary care referral is required for all Public Aid appointments including those treated in the Emergency Department. Public Aid recipients need to provide a current Public Aid card for every scheduled appointment in order to receive services. Commercial IDPA plans in which we do not participate in require pre-authorization for the visit. If this pre-authorization is not obtained for your visit by your primary care physician, your appointment will be rescheduled. Any co-pay designated on the card is required to be paid at the time of service.
Workers’ Compensation/Employment Injuries
All treatment under workers compensation must be pre-authorized in writing by your employer or workers compensation carrier. No appointment will be made if there is no prior approval, if the claim is disputed or denied, or if the patient is considering filing a workers’ compensation claim. Once authorization or determination by Illinois Workers Compensation Commission has occurred, the patient is encouraged to contact our office to discuss an appointment.
If a workers compensation carrier denies further authorization for patients already under care by Midwest Ear, Nose & Throat it is the patient’s responsibility to contact their health insurance carrier to receive approval for continued treatment.
Accident Case Liability/Auto Accident Injuries
If your injury is a result of a liability, you must provide that information at the first visit including any attorney information. We will bill your liability carrier as a courtesy if we can obtain verification of the incident with the carrier. Once the liability insurance has maxed the patient’s health insurance will be billed. Ultimately, the patient is responsible for the billed services 30 days after initial billing. Please note that litigation is NOT considered a valid reason to withhold payment for services. Collection action will begin after no payment is received.
Midwest Ear, Nose & Throat offers a financial assistance program to patients who have no insurance to cover their expenses. In order to qualify, applicants must provide a denial letter from Illinois Public Aid and complete an application that can be obtained by contacting our billing department. Copies of pay stubs, income tax returns, bank statements, household bills, etc. are required. Income limits used to qualify are set at a percentage of the annual poverty guidelines as supplied by the department of Health and Human Services. Acceptance of other facility Charity Programs is granted on a case-by-case basis and requires a hardship letter and a copy of the facility approval letter for consideration. For more information, please contact our billing department.