Comprehensive Patient Financial Policy 
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Thank you for choosing Treasure Valley Nasal & Sinus Center, PLLC. We are committed to providing you with  quality otolaryngologic health care. Please understand that payment of your bill is part of your care. To help  avoid misunderstandings, we have provided you with details of our financial policy below. 

Insurance. We participate in most insurance plans, including traditional Medicare and Medicaid and Medicare Advantage plans. If you are not insured by a plan we accept, payment in full is expected at each visit. We will also  make every attempt to contract with the health insurance plan. If we do accept your plan, but you do not have a  current insurance card, payment in full for each visit is required until we verify coverage. Knowing your insurance  benefit plan is your responsibility. Please contact your insurance company with any questions you may have regarding your coverage. 

Co-payments. All co-payments must be paid at the time of service. This arrangement is part of your contract with  your insurance company. Failure to collect co-payments and deductibles from patients is considered fraud. Please  help us in upholding the law by paying your co-payment at each visit. 

Payment. We accept payment by cash, check, money order, debit card, VISA, MasterCard, or Discover. All  previous balances must be paid at time of service, unless prior arrangements have been made. If a check is  returned for insufficient funds or payment has been stopped, you may be charged a $30 fee in addition to the  amount of the check. If you have a second check returned, you will be asked to pay by cash, money order,  cashier’s check, or credit card for future visits. Failure to pay for medical services may result in a patient being discharged from the practice. 

Self-Pay. A minimum $50 payment for existing patients and $100 for new patients is due prior to treatment from  all uninsured patients. You will have 60 days to pay your balance in full. 

Co-insurance and deductibles. Your co-insurance and/or deductible balance is due when you receive your  explanation of benefits from your insurance company. 

Minor Patients. The following parties are responsible for payment of all minor patient balances: the adult accompanying the minor and the parents (or guardians). 

Cost of Service Is Undeterminable. If the total cost of the visit is not able to be determined at check out, you will  be asked to make an estimated payment and will be billed or credited the difference. We will work with you to  settle your account. Please ask for assistance regarding an extended payment schedule. 

Proof of insurance. All patients must complete our patient information form periodically prior to seeing the  doctor. We must obtain a copy of your driver’s license, your current insurance card and your social security  number in order to confirm proof of insurance and file your claim. If you fail to provide us with the correct insurance information in a timely manner, you may be responsible for the balance of a claim.

Claims submission. We will submit your claims and assist you in any way we reasonably can to help get your  claims paid. In order to submit claims we must have the patient's date of birth, social security number and a copy  of your photo identification (when applicable). In addition, we must obtain the policyholders date of birth and  social security number in order to file claims with your insurance carrier. We will file supplemental insurances when appropriate. Your insurance company may need you to supply certain information directly. It is your  responsibility to comply with their request. 

Coverage changes. If your insurance changes, please notify us before your next visit so we can make the  appropriate changes to help you receive your maximum benefits. 

Nonpayment. If your account becomes delinquent, you agree to pay any charges to collect your unpaid bills,  including but not limited to, reasonable court costs, and/or collection agency fees. After you have received two statements, your account is considered past due. At that time, you will receive a letter stating that you now have  10 days to pay your account in full. Payment plans may not exceed a 6-month time period, unless otherwise  negotiated. You must contact us for a reasonable payment arrangement or risk collection action. Please be aware  that if a balance remains unpaid, we may refer your account to a collection agency or a collection attorney and  you and your immediate family members may be discharged from this practice. If this is to occur, you may be notified by mail that you have 30 days to find alternative medical care. During that 30-day period, our physician  will only be able to treat you on an emergency basis. 

Missed appointments. Missed appointments represent a cost to us, to you, and to other patients who could have  been seen in the time set aside for you. We reserve the right to charge a fee for canceled or missed appointments. For cancellations, 24-hour notice prior to the appointment is requested. Treasure Valley Nasal &  Sinus Center, PLLC reserves the right to terminate our medical relationship due to repeat patient appointment  cancellation or failure to appear. If the relationship is terminated, Treasure Valley Nasal & Sinus Center, PLLC will  provide written notice to you as required by Idaho law. The only exception to billing for a no-show appointment is when a state and/or federal policy exists that precludes billing the patient for a no show ormissed appointment. 

Referrals. If you have insurance that requires a referral, we must have your referral prior to receiving treatment. 

Worker’s Compensation or Motor Vehicle Accidents. It is your responsibility to file a report with your employer  or automobile insurance. If you are injured on the job, please let the receptionist know so we may contact your  employer to facilitate filing your claim. If you are injured in a motor vehicle accident, please bring your automobile insurance card. 

Interpretation Services. Should interpreter services be required, please notify our office prior to the  appointment. We have guidelines relative to who can provide interpreter services. Be certain to notify staff if you  are bringing an interpreter with you to the visit so that we can provide the guidelines for you. If you do not have  an interpreter, we will make arrangements to provide one. 

Insurance Info. Here are a few of the insurance companies we contract with. Always contact your insurance  company to verify we are in network as contracting provider with your insurance. We will bill all insurances.  However, if we are not in network with your insurance, you are required to pay in full at the time of service. 
  • Blue Cross (PPO & Traditional)
  • Regence Blue Shield (PPO & Traditional)
  • St. Luke's Employees' Insurance
  • Idaho Physician's Network (IPN)
  • Idaho Medicaid 
  • Medicare - (red, white and blue card) 
  • Medicare Advantage plans
  • Pacific Source 
  • Multi Plan or PHCS 
  • Select Health 
  • Aetna 

Our practice is committed to providing the best treatment to our patients. Our prices are representative of the  usual and customary charges for our area. Thank you for understanding our payment policy. Please let us know  if you have any questions or concerns.
 
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