Billing & Insurance FAQs

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, we are unable to see you as a patient. 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.

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.

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.

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.

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.

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, American Express 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.

Yes. We offer 0% interest financing and leasing payment plans. Please contact our audiology department for more information.

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.

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 Professional Credit Services.

A “No-Show” is defined as a patient who fails to reschedule more than 24 hours before their scheduled visit or arrives more than 15 minutes late to the appointment. 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 No-Show fee for New Patients is $100.00 and for Established Patients, the fee is $75.00. If there are 3 No- Show occurrences, the provider with whom you’re scheduled may decide to discharge you from their clinic, or a $75.00 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.