Please remember to have the patient ID number and your child’s date of birth (DOB) ready to make a payment.
If you have any questions, call Pediatric Ear, Nose & Throat of Atlanta billing department at: 404-845-0565.
Patient Financial Responsibility Policy
Pediatric Ear Nose & Throat of Atlanta, P.C. (PENTA) will make diligent efforts to inform patients of their financial responsibilities in a manner that promotes compliance, patient satisfaction and efficiency. Through the use of billing statements, written correspondence, phone calls, texts or e-mails, the goal is to provide patients with clear and consistent guidelines regarding how PENTA conducts billing and collection functions for outstanding accounts. It is your responsibility to provide our office with complete and accurate insurance or billing information at the time of service.
You must bring your current insurance card to every visit. As a courtesy, we accept assignment of benefits for primary and secondary insurance. However, our office cannot guarantee the dollar amount that an insurance company agrees to pay. You are responsible for payment of all services rendered to your child that insurance does not cover.
As a courtesy to all our patients, we will file insurance claims to your primary and secondary insurance carrier. Your insurance is a contract between you and the insurance company and we are not a party to this contract. We have no control over the terms of your contract, the method of reimbursement or the determination of benefits. Any disputes with insurance companies over payments or lack thereof are the responsibility of the insured.
Please be aware that the parent or guardian who signs this consent form is legally responsible for payment – regardless of whether or not they are the insurance holder. Our office must be informed of all insurance changes and authorization/referral requirements. In the event the office is not informed, you will be responsible for any charges denied.
In the event of separation or divorce, the parent or guardian who signs this form is legally responsible for payment. We cannot send statements to other parties. Reimbursement methods must be made between divorced parents. We will not intervene.
It is your responsibility to inform us in a timely manner of any changes to your billing information. In the event the office is not informed, you will be responsible for any charges denied.
If your insurance requires an authorization for office visits or procedures, it is your responsibility to make sure we have authorization prior to the visit or service.
If you want to be seen without an authorization, you will be considered a self-pay patient and required to pay in full for all services.
Patients may also receive a monthly statement for any unpaid services by patient or insurance.
Please note: All health plans are not the same and do not cover the same services. In the event your health plan determines a service to be “not covered” or you do not have an authorization, you will be responsible for the complete charge.
Patients are expected to pay for all estimated co-pays, deductibles and co-insurance at the time of service as required by your insurance company. We expect you to come prepared to pay your co-pays on the day you receive service.
If you are unprepared to pay your co-payment at the time services are rendered, you can reschedule your appointment for another time when you will have your co-payment with you – OR – agree to pay us an additional $10.00 fee that will be added to your account for the collection costs of your co-payment.
Past Due Accounts
Accounts cannot carry balances longer than 60 days; regardless if insurance payment is still pending. If the insurance company does not pay the practice within 60 days, we will look to the responsible party for payment.
If we later receive payment from the insurer, we will refund any overpayment. If payment has not been received after 90 days, we will inform you of the delinquent account and if no action is taken to clear the account, this office will employ a collection service to collect payment. The responsible party agrees to pay any fees associated with the collection of the account.
Although we have specific prices assigned to each service we provide, we require self-pay patients pay an upfront cost of $250. A final determination of cost cannot be made until the physician, nurse practitioner or physician assistant has seen your child.
There are different levels of office visits, which are determined by the complexity of the condition and/or time spent with the patient. There are also additional charges for microscope, audiology (hearing test), labs, and procedures that are not known until the services are provided.
You may contact the Billing department at 404-845-0565, if you have any additional questions regarding your financial responsibility.