Financial + Insurance Policy (Form 5 of 5)

Thank you for choosing Alamo ENT Associates as your healthcare provider. Please understand that insurance reimbursement can be a long difficult process. Therefore, it is important for you to understand your insurance policy and coverage.

Please take a minute to do the following:
1. Check with your insurance company to determine if authorization is required for specialist visit and/or procedure.
2. Find out which diagnostic facilities you can go to.
3. Check with your insurance company to determine how much your co-pay, deductible and co-insurance are and how they apply to the visit and procedures.

All co-pays, deductibles, and co-insurance are due at the time services are rendered.

Copay + 35% of Procedure Charges or 35% of Total Charges if your policy does not have a Copay

We are no longer participating with Medicaid

Our office must stay in compliance with our insurance contracts, which require us to collect co-pays, deductibles and co-insurance to the best of our knowledge. We cannot discount or waive these patient responsibilities without jeopardizing our contract with your insurance carrier. If you have any issues or concerns regarding your insurance we will be happy to assist you.

Please feel free to contact our billing office with any questions at (210) 616-0121

  • The parties agree that this form may be electronically signed. The parties agree that the typing their name in the signature box is the same as a hand written signature for purposes of validity, enforceability and admissibility.