Financial Agreement and Office Policies
Downtown ENT
Thank you for choosing Dr. B. Thuy Le at Downtown ENT for your ENT specialty care. We strive to serve you with the utmost professionalism and to provide the best treatment options. Please take the time to read our office policies, as we would like to ensure a smooth and pleasant visit and prevent financial confusion afterwards. If you have any questions, feel free to reach out to our office regarding any fees and financial responsibilities.
Required forms: Patient Information, Financial Agreement, Medicare Assignment of Benefits (AOB) or waiver.
In-Network: We will confirm your active insured status and eligibility and that Dr. Le has an in-network contract with your plan. To the best of our ability, we will also inform you of copayments or deductible amounts that are applicable to your visit.
Out-of-Network: We will advise you if the doctor is out-of-network with your plan and inform you of any pertinent cost. You are required to pay your deductible at the time of service as contracted by your carrier.
Referrals: HMO and some EPO insurance require a referral from their primary care physician. Please call your PCP to obtain a referral PRIOR to your scheduled appointment. It must be done before the visit. Without a referral, you will be responsible for the cost of your office visit out of pocket because we are unable to submit the claim for the office visit to your insurance company.
Copayment: Copayments are contracted amounts between you and your insurance company for each office visit (contractual cost-sharing). You are required to pay your copayment at each office visit. Dr. Le is an ENT specialist and therefore you may have a copay here even if you do not at your PCP (specialist copay, surgery specialty copay). This cannot be waived under contract rules.
Deductible: If you have a deductible on your plan, it is the amount you must pay before your insurance starts to pay for covered costs. This may result in receiving a bill from us for the total covered allowable costs for your visits until the deductible is fully met.
Coinsurance: Coinsurance is a percentage of the visit cost. The difference between coinsurance and a copay is that a copayment is a set flat rate, and coinsurance is a percentage and therefore varies. Please contact your insurance company for further explanation, as the percentage of plans can be different in different settings (office vs. hospital vs. diagnostics).
Uninsured/Self-Pay Patient: Self-pay patients will be charged the current rates; generally the first visit falls under a consultation fee and subsequent visits are charged follow up rates. The final cost of each visit is determined by the level of detail of the visit and any procedures performed during the visit.
“Covered by insurance”: This common phrase indicates that if we are in-network with your insurance/accept your plan, the insurance dictates the prices so you are not charged a full non insurance fee. However, you may still have to pay up to the full amount of that insurance price if you have a deductible and therefore will have an account balance directly with us.
Medicare: Medicare patients are expected to sign Medicare Assignment of Benefits at initial visit and some interval. This will allow the office to send billing and medical records to Medicare when required by all contracted Medicare providers who are regularly monitored by CMS. Please provide us with your secondary insurance, since Medicare part B alone provides 80% coverage. If you do not have secondary coverage or do not provide the secondary, you will incur a bill for the remaining 20%. Signing this form constitutes the initial assignment of benefits to Dr. Le from Medicare by the insured.
Nasal Endoscopy/Fiberoptic Laryngoscopy/Diagnostic Procedures: To provide you with the best care, Dr. Le will commonly perform a nasal endoscopy or laryngoscopy with a flexible or rigid fiberoptic telescope in order to diagnose you properly. Any diagnostic procedure is done if it is essential and necessary to evaluate you and there is no substitute. These are separate charges on a bill for the visit, whether it is a bill to insurance or a bill to you if you do not have insurance. You may be responsible for a deductible or coinsurance for these diagnostic procedures if your insurance applies the allowable charges to your deductible and/or coinsurance. If you prefer not to have a diagnostic done, you may sign a refusal of service.
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