I understand that charges not covered by my insurance company or my secondary insurance if applicable, as well as any applicable co-payments, coinsurance, and deductibles are my responsibility. All professional services rendered are charged to the patient and are due at the time of service, unless other arrangements have been made in advance by either the patient or his/her health insurance carrier. If your insurance company has not paid your account in 90 days, the balance may be transferred to you for payment.
If your insurance is with an HMO or other managed care program, Texas Ear and Vestibular Institute will bill them only if you present an appropriate authorization form from them. You may still be responsible for any deductibles, co-payments, or non-covered services. If you do not have an appropriate authorization each visit and/or treatment, the responsibility for the payment will be yours.
For companies with whom our physicians do not participate, payment for the first visit for the services is your responsibility. Texas Ear and Vestibular Institute will bill to your insurance carrier after second visit.
I understand that if I default on payment for services, that my account my be transferred to an independent collection agency, designated as credit risk and payment for services will be required at the time of registration for all future visits. I have read the financial policy as above. I understand and agree to above financial policy.
We currently accept cash, Visa, Mastercard, and American Express. Unfortunately, we are not accepting checks at this time. If you have any questions regarding your bill, please contact our billing office, CureMD, at 347-732-1357.