Ear, Nose & Throat Associates of the New York, P.C is joining ENT and Allergy Associates, LLP effective July 1, 2022.
Read our joint press release or visit the website to learn about our new team.

Billing Questions | Ear, Nose & Throat Associates of N.Y., P.C.

Billing Questions

Please contact our Billing Department should you have any questions regarding your bill.

My insurance EOB lists “surgery,” I didn’t have surgery.
Insurance companies classify anything that’s invasive (such as drawing blood, removal of ear wax, inserting an endoscope in your nose, etc.) as surgery.

You “accept” my insurance, why am I getting a bill?
We participate with most insurance plans, meaning we accept their determination as to what and how much they allow. You are still responsible for any deductible, copay, non-covered charges, and/or co-insurance that your insurance company states are your responsibility.

I paid my copay, why am I getting a bill?
Some insurance plans assess a second copay for tests, the specialist copay may be higher than the PCP copay listed on your card, your copay may have gone up, or the bill may be in error (please contact our billing department at 718.661.6617.

What is co-insurance? I paid my copay, why do I have con Insurance?
Co-insurance is a percentage of the bill for which you are responsible. Medicare (as an example) approves a certain amount and then pays 80% of that approved (or allowed) amount; you (or your secondary insurance) are responsible for the 20% (co-insurance) balance. Some insurance plans assess copays and also have a patient co-insurance responsibility.

I have insurance, why am I getting a huge bill?
Please call our Billing Department 718.661.6617. Your claim may be pending your contacting your insurance company to update your eligibility (student status, coordination of benefits, proof of prior coverage, pre-existing condition review, accident details, etc).

What is “Coordination of Benefits” (COB)?
COB refers to which insurance company must (by law) pay first. In most cases the patient’s insurance must be billed first (the “primary insurance”) while the spouses insurance is “secondary.” If you have Medicare but you (or your spouse) are still working, the insurance through your (or your spouse’s) employment is often primary and must be billed first. A child with insurance through both parents generally has the insurance of the parent whose birthday (month/day) falls earlier in the year as his/her primary insurance.

I paid my Medicare deductible to another doctor, why am I getting a bill?
Medicare (and most insurance plans) applies the deductible to your earliest claims that they completely process. Our claim may have reached Medicare before the other doctor’s, or the other doctor’s claim could not for whatever reason be processed. Your Medicare EOB will tell you which doctor you actually owe (and how much the doctor can charge you).

Why wasn’t I told ahead of time of my large deductible? Why wasn’t I told ahead of time that my insurance would not pay for these charges? Why wasn’t I told ahead of time that I have a $100 copay for this charge?
While we attempt to verify our patients’ benefits, it’s not possible for us to know the plan provisions of each individual insurance plan. We participate with hundreds of insurance plans, each of which may have dozens (or hundreds) of separate contracts with different plan provisions. It is your responsibility to know your benefits package or to check with your insurance company as to whether you are covered for visits to our doctors and offices.

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