Our practice believes in providing exemplary medical care and service. When we are scheduling surgery for you, there are many steps which occur “behind the scenes” and require a great amount of effort from our staff as well as obligations which you, the patient, will need to fulfill.

SUMMARY OF SCHEDULING PROCESS

WHAT TO EXPECT FROM US:
When we schedule surgery for our patients, the following takes place:

As this is such a time and work intensive process, we do not cancel and reschedule surgical dates lightly. Times may change up until the day before your procedure (due to ages of patients, instrumentation, etc.), but the date changing means that the above steps must be repeated. For this reason, we must charge a surgical re-booking fee of $100.00 if this occurs for reasons which are preventable.

Additionally, there will be a charge of $250.00 per hour booked for patients who do not arrive for surgery.

WHAT WE WILL EXPECT OF YOU:

• The patient (or responsible parent/guardian) will need to read the forms and instructions that we provide carefully and ask questions if needed.
• The patient (or responsible parent/guardian) will need to provide any dates which will NOT work to the surgical coordinator within 24 hours of the date on this form.
• The patient will need to contact their insurance company directly to obtain benefits and coverage information and discuss financial obligations (even if we provide you some of that information).
• The patient will need to schedule any pre-op and post-op appointments in advance.
• The patient will need to pay any required co-payment to our office in advance of surgery.
• The patient may need to assist in obtaining any required referral forms from the PCP.
• The patient will need to follow ALL instructions given (see pre-operative instruction sheet) so that surgery is not cancelled for a preventable reason (see surgical re-booking fee above).
• The patient will need to arrive ON TIME (see arrival time) for surgery in order not to be cancelled.

ANSWERS TO BILLING QUESTIONS YOU MAY HAVE REGARDING YOUR SURGERY. PLEASE READ BEFORE CONTACTING OUR BILLING OFFICE ABOUT YOUR BILL.

We strongly encourage you to personally contact your insurance company about your upcoming surgery. It is recommended that YOU, as the insurance subscriber, confirm that all prior authorization information necessary to your specific policy is completed before your surgery date. You may be penalized by your insurance company if you don’t follow your policy guidelines. You must understand what your benefits cover and how this may affect you financially.

There are a number of separate charges associated with your surgical procedure. You may receive billing statements from several companies.

Maryland ENT Associates	His/her fee for performing your surgery
Surgery Center or Hospital	Facility fee
Anesthesiologist	His/her fee for anesthesia during your surgery
Pathologist	Services for tissue specimens removed during surgery requiring further examination
Other Charges	As required by the patient’s individual needs

Prior to your scheduled surgery date, we will contact your insurance to confirm your eligibility and benefits. We will also obtain authorization, if needed, for the planned procedure. Insurance companies WILL NOT guarantee payment when we call for authorization. However, you will be notified if they do not authorize the procedure or require it to be performed at a different location.

ALTHOUGH YOUR INSURANCE COMPANY MAY TELL YOU THAT YOU ARE “100% COVERED”, THIS DOES NOT INCLUDE ANY CO-PAYS, CO-INSURANCES OR DEDUCTIBLES THAT THEY APPLY.

If you have any anticipated out-of-pocket costs (co-pay, co-insurance, deductible, etc.), we will obtain an ESTIMATE for you based on the procedure scheduled by your surgeon. We may request that any anticipated out-of-pocket costs (co-pay, co-insurance, deductible) be paid prior to the date of your surgery. Please understand this is only an ESTIMATE. There may be additional costs to you based on the actual procedure(s) performed at time of surgery.

We will submit insurance claims for you, to your primary, and if applicable, secondary carrier. Most carriers provide their subscribers with an “Explanation of Benefits”, which describes how they processed your claim. If your insurance company denies payment, this explanation will tell you why. You may also wish to call member services at your insurance carrier if you do not agree with the amount of your co-pay, co-insurance and/or deductible. Please remember, these amounts are owed according to your insurance policy, not determined by our office.

You are ultimately responsible for the total bill or any portion of the bill that your insurance carrier did not pay. Our billing department makes every effort to work with your insurance company to get your claim processed in a timely manner. Occasionally, we are unable to resolve the issue with your carrier and will need your assistance. You may not be aware that payment is being held because you need to supply your insurance with more information regarding other insurance coverage and/or accident information. This information can only come from you, the subscriber.

Additionally, after surgery a certain amount of post-operative care may be included in the surgical fee for a short time. The included care DOES NOT include special diagnostic or treatment procedures such as audiology evaluation, use of endoscopic equipment, etc. During this time, we may not collect a co-pay BEFORE your office visit, but we do ask that you stop at the check-out desk AFTER your visit to pay any necessary co-pay.

If you have additional questions about the bill you received from our office, please call our billing department at 800-973-1442.

If you have questions about the bill you received from the facility, anesthesiologist or pathologist, call the phone number listed on their billing statement.

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