News / March 25, 2021
By Kelly Warf, Au.D.
Susan Forman, CCS-P
David Tojo, M.D.
Many are unaware of what happens between giving their health insurance information to a medical office and the bill they receive from the appointment. Health insurance is an important investment. However, just because you have medical insurance doesn’t mean you won’t be responsible for part of the cost of a visit or surgery. Health coverage reduces your out-of-pocket medical expenses. Let’s break down how health insurance and medical billing works.
First, health insurance is an agreement between you and your medical insurance company. Once you select your policy, you are enrolled in a network of providers who accept that plan. An in-network provider has agreed to the negotiated rates from the insurance company. Going to an out-of-network provider may yield a higher cost for their service. While private insurance companies have negotiated rates, Medicare has set prices.
In your contract with the insurance company, you have agreed to the following expenses in order to receive health coverage:
At the time of scheduling your appointment, we will request your insurance information and let you know if we are out of network or if a referral is required.
At the Ear, Nose, and Throat Center, we only perform necessary services to diagnose and treat. Since your ear, nose, and throat are all connected, what presents as a symptoms of ear pressure may end up as an evaluation of your sinus cavity. The services, prescriptions, and supplies used during your appointment are submitted to your insurance. The amount that a physician charges for an office visit or a procedure is a standardized fee according to the state/area fees. A claims processor from your insurance company reviews the submission and then decides to accept or reject it. The insurance company then sends its decision to the medical office and policyholder, this statement is known as the Explanation of Benefits (EOB). The EOB explains if the services were accepted or rejected and why. If the health insurance does not cover the service, then the healthcare provider may bill you for the remaining balance. Please note that the EOB is not your medical bill.
Wonderful office staff and doctor. Very professional and accommodating. Really care about the patient.
The doctor and the staff were all nice and professional. I was seen within the first five minutes of showing up. I got quality care and review of my concerns.
Actually takes the time to talk to you and figure out your concerns.
About Ear, Nose, and Throat Center
The Ear, Nose, and Throat Center (ENT) is the premier Otolaryngology – Head and Neck Surgery group in the northern Chicago suburbs. Our skilled and compassionate doctors can provide you with the latest advancements in total care for diseases, cancer, and disorders affecting the ears (including hearing), nose, mouth, allergy, sinuses, throat, head, and neck. We offer the highest level of specialty care for all ages from pediatric to geriatric.
We have two offices located in Park Ridge and Buffalo Grove, enabling us to conveniently serve patients in the surrounding Chicago suburbs including Arlington Heights, Des Plaines, Mount Prospect, Niles, Palatine, Rosemont, Wheeling, and more in Cook and Lake counties.
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