- 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.
Cancellation & No Show Policy
- 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.
Insurance Cards & Insurance Filing
- 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.
Liability & Workers Compensation
- 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.
Extended Payment Plans & Financial Assistance
- Please call our billing office to discuss any extended payment plan options.
Termination/Discharge from Practice
- 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.