Financial Policies

Will my insurance cover this visit?

In most cases, yes. Camino Ear Nose & Throat Clinic accepts all PPO insurance and is in network with several different HMO’s as well. We do our best to help you know before you come in if your insurance will cover a visit with us. It is, however, ultimately your responsibility to know your plan, whether your insurance information is current (you will be asked) and to check with your carrier first to make sure we will be considered in-network for your visit. If you have an HMO, you are responsible for knowing whether an authorization has been issued for your visit. If we have reason to believe that your insurance will not cover something, we will have you sign an Advanced Beneficiary Notice beforehand, giving you notice. We do not accept Medi-Cal. Therefore, if you have Medicare/Medi-Cal you will be responsible for your secondary portion. If you have international medical insurance we cannot submit those claims on your behalf. You will be treated as a “Cash Pay” patient and will be given the necessary documents so that you may file a claim with your carrier.

Why am I being asked for a credit card and how will it be used?

We cannot see you if you do not have a credit card on file with our office. Our policy is to inform patients when they make the appointment. If you were not told, please let us know. Over the last seven years we have seen patient copays/coinsurance/deductibles go from approximately 10% of our income to 35%. We are sure you also have noticed that your bills from physicians’ offices have gotten larger as well. Our charges have not increased. The costs of healthcare shared by carriers and patients are increasingly being allocated to patients (lower premium, higher deductible plans) and we are being instructed, per your carriers, to send the bill to you. When you are in our office you will be asked verbally if you would like to use your credit card on file for your standard co-pay or for any unpaid balance. You will be given a receipt. If there is an outstanding bill for which you have received more than two statements and have not called with a question or have not mailed in an alternate form of payment, the outstanding balance will be charged in full.

What does it mean to be in a specialist’s office?

Specialists’ offices bill very differently from General Practitioners and Pediatricians. We do not have a global office visit code available to us to bill under that covers everything that happens in our office. Specialists must separately document and code every procedure and exam they conduct. Each code may generate a separate charge. So you may get a bill from our office if your carrier indicates that is what your plan requires. Our providers do not know your individual situation and nor do they know the wide variety of policies of various insurers regarding different charges, so please don’t ask them in the exam room. Let them focus on you and let our billing department help you understand and manage any charges that arise as a result of your visit.

How much will this visit cost me?

Short answer: we don’t know beforehand (see the section above as to why). If you have insurance, you may have a co-pay, coinsurance and/or a deductible. Every patient and plan is different.

Do you accept non-insured (“Cash Pay”) patients?

Yes. We offer non-insured patients rates that are comparable to the average reimbursement from an insurance company. We do not charge more than the average and we may not, per our contracts with insurance companies, charge less. If the balance is large, a “Cash Pay” patient should discuss their payment options with our billing specialist, so a plan can be made and care not delayed. We do not want patients to avoid seeing a provider out of concern over a charge.

How and when do I pay?

For our insured patients we ask that you pay your copay at the time of your visit. For our non-insured patients, your charges will be determined at the end of your visit and we ask that you pay the outstanding charges, unless an alternate arrangement is made. All charges may be settled using cash, checks, Visa, Mastercard or Discover. You will receive a statement from our office showing what remittance advice, if any, we received from your insurance company. All undisputed amounts owed should be paid within 30 days of you receiving your first statement. After two statements are sent, the credit card on file will be charged.

Do you offer payment plans?

Yes. We offer 0% interest payment plans. The most important thing is that you call and speak with our billing specialist to arrange a plan as soon as you are aware that you need some assistance in managing the payment. The credit card that is kept on file with our office will be used to collect the agreed upon amounts at the agreed upon dates.

Am I able to negotiate my balance with Camino Ear, Nose & Throat Clinic?

Not really. If you are an insured patient, your agreement with your insurance company dictates how your charges are to be shared between you and your insurance carrier. We send the charges to your carrier; they tell us how to allocate the charges. Our agreement with them is very clear – we must collect what is owed or we can be dropped as a provider. For non-insured patients our insurance contracts still dictate that our minimum charges cannot be less than they reimburse. If you are under a financial hardship and even an interest free payment plan will not suffice, there is a process by which you can document your hardship to the satisfaction of your insurance company (it involves pay stubs and bills) so that we will be allowed to reduce somewhat the amount you owe.

Do you send patients to collections?

Yes, unfortunately. Any balances that remain unpaid for more than 90 days from a final determination by your carrier as to the correct charges will be sent to collections. The company we use is Arcadia Recovery Bureau, LLC.

Is there a fee for not showing up or showing up late for a scheduled appointment?

A “No-Show” is defined as a patient who fails to reschedule more than 24 hours before their scheduled visit. For Monday appointments, this means by the prior Friday at noon. If you call our office more than 24 hours before your visit to let us know you cannot make it, there is no charge. The fee for the first “No-Show” is $35.00. The second is $70.00. If there is a third no- show, the provider with whom you’re scheduled with may decide to discharge you from their clinic or, another $70.00 charge will be incurred. We really dislike having to do this, but we really need some notice to allow other patients to schedule. We turn away other people needing care in order to hold a place for a patient. If there are extenuating circumstances, we’re open to discussing them.

Click here for a downloadable copy of our financial policies.