Financial Policy Thank you for choosing Plymouth Ears, Nose, and Throat as your medical care provider. We are committed to delivering the highest quality of care while ensuring transparency in our cost and billing practices. This includes providing you with the necessary information upfront and helping you make informed decisions. It is important to understand that the relationship is between the medical provider and the patient — not with the insurance company. Patients are responsible for understanding their healthcare coverage, including what services are covered, their financial responsibilities, and any guidelines set by their insurance provider. For your convenience, this document addresses some commonly asked financial policy questions. If you need further information, please ask to speak with our Practice Manager. Do I need a referral or pre-authorization? If your insurance plan requires a referral from your primary care physician or a pre-authorization from your insurance company, you are responsible for ensuring this is obtained prior to your appointment. If we have not received authorization before your visit, we will need to reschedule. Failure to obtain proper authorization may result in reduced or no payment from the insurance company, and the balance will become the patient's responsibility. When are payments due? Payments are due at check-in, unless prior financial arrangements have been made. These payments may include copayments, deductibles, and any past-due balances. If a copay is due and not paid at the time of the visit, your appointment may be canceled. Returned checks or payments will result in a minimum $35.00 penalty in addition to the outstanding balance. What if my insurance is not accepted by your office? We follow the No Surprise Billing Act and will ask you to sign an out-of-network form that outlines all relevant details and payments. We will bill all commercial and non-contracted insurance plans as a courtesy, as many may have out-of-network benefits. Any unpaid or partially paid balances after 30 days from the initial insurance submission will become the patient’s responsibility and are due upon receipt of the first statement. Will you bill my insurance? Yes, we bill your primary insurance company on your behalf. However, your insurance policy is a contract between you and your insurance company, and in most cases, the terms are not disclosed to us. To properly bill claims, all necessary and current information must be provided. Any changes to your name, address, or insurance coverage should be communicated to us prior to your next appointment. Failure to provide accurate and complete information may result in the full bill becoming the patient’s responsibility. What if I don’t have insurance? Uninsured or "self-pay" patients will be required to make an initial deposit of $350.00 at the time of service. Pricing and payment options can be arranged through our billing department. If there is a discrepancy with the insurance information on file, the patient will be considered self-pay until resolved. At the practice's discretion, extended payment arrangements may be offered. It is never our intention to cause financial hardship. Our goal is to provide quality care at affordable costs. Why did I receive more than one bill for my surgery/procedure/testing services? While we bill only for services rendered by our team during appointments and procedures, certain testing services may be performed by outside labs or facilities. We do our best to use participating providers, but this is not always possible. This may result in separate deductibles, copays, and coinsurance claims. As a specialty office, some insurance plans classify our procedures as “surgery,” which can trigger surgical copays or deductibles. Most patients will require a nasal scope for accurate diagnosis — these may result in charges up to $1,000. If you do not wish to undergo a scope, please notify your provider at the time of your visit. Common procedures and tests we perform include: Nasal Endoscope Nasopharyngoscopy PH/Manometry Allergy Testing Ultrasounds Strobe Exams Debridement Fine Needle Aspiration (FNA) All types of nasal scopes What is a deductible? A deductible is the portion of your healthcare cost you are responsible for before your insurance starts paying for covered services. This is determined by your specific insurance plan. We strongly recommend that patients contact their insurance provider prior to their appointment to understand their deductible amounts and remaining balances. What if I miss my appointment? We understand that life happens, and sometimes appointments can't be kept. However, our clinical team sets aside time specifically for you. If you're unable to attend, we ask for a minimum of 24-hour notice to avoid a missed appointment fee. Appointment No-Show Policy: We require 48-hour notice to cancel or reschedule any diagnostic testing appointments. Otherwise, a No-Show Fee of $25.00 will be charged to the responsible party. This includes (but is not limited to): A/V Testing Allergy Testing PH/Manometry FNA Strobe Exams Ultrasounds

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