Financial Policy | Palmetto ENT & Allergy

Palmetto ENT & Allergy

Patient Registration

You will be asked to complete a registration form each year and update and/or confirm the accuracy of this information at every visit.
For your protection, we require personal identification. Bring your driver??s license or picture ID on every visit or front office check in system.
Our registration form is available on our website.

We require 24 hour notice if you wish to cancel and reschedule your appointment.
A $35.00 fee will be charged for no show or late cancellations.
A nonrefundable $50.00 security deposit will be required to make an appointment for patients who frequently no show.

As a courtesy to all our patients, we will file insurance claims to your primary and secondary insurance carrier.
You must bring your current insurance card to every visit to file insurance claims on your behalf. It is your responsibility to inform us in a timely manner of any changes to your billing information.
If an insurance company denies payment for incomplete or incorrect information provided by you or for noncovered services, you will be expected to pay for services in full.
If we do not participate in your insurance plan, be aware your benefits may be reduced.
We do not file school or automobile insurance.
We do not participate in any hospital affiliated Charity Programs.

If your insurance requires an authorization for office visits or procedures, it is your responsibility to make sure we have authorization prior to the visit or service.
If you want to be seen without an authorization, you will be considered a self pay patient and required to pay in full for all services.

Our physicians are Board Certified and use the latest diagnostic technologies to effectively diagnose and treat problems of the ear, nose, and throat.
During your visit, you may undergo diagnostic testing for a complete ENT evaluation of your problem.
Patients with sinus problems may have a nasal endoscopy procedure performed at their visit.

We accept Cash, Check, Money Order, Visa, MasterCard, Discover and American Express.
Patients are expected to pay for all estimated co-pays, deductibles and coinsurance at the time of service as required by your insurance company.
Patients may also receive a monthly statement for any unpaid services by patient or insurance.
Returned check fee of $25.00
Medical record fee of $25.00 in advance for completion of disability forms.

It is impossible to determine what the cost of the care will be prior to the date of service.
We require a minimum payment of $200.00 up front prior to seeing the doctor for new self pay patients.
Additional payment may be required at time of checkout for services rendered.

Patients who do not have insurance will receive a 20% discount on charges if paid in full on date of service.
Patients will be billed for any balance not paid at checkout due upon receipt of statement.

We require written authorization by your employer or workers compensation carrier PRIOR to your visit. If you claim is denied, you are responsible for payment in full
We do not accept assignment in the case of liability/legal actions.
Payment of the bill is the responsibility of the person receiving treatment

Patients under the age of 18 must be accompanied by the parent or guardian.
The parent who consents for treatment will be the responsible party on the account and is responsible for all charges regardless of divorce or separation decree.
We request patients age 18 or older covered under their parents insurance to sign an authorization allowing Palmetto ENT & Allergy to contact parents regarding insurance and billing issues.

All patients are expected to pay a deposit prior to surgery. Please refer to our Surgery Financial Policy.

The following scenarios may jeopardize the patient/physician relationship in which Palmetto ENT & Allergy will terminate and discharge the patient from the practice. The patient will be sent a letter of discharge.
- Noncompliance/Abusive Patients
- Excessive no shows
- Failure to meet financial obligations.