Billing Policies & Procedures

Managed Care places specific responsibilities on Physicians and Patients. These responsibilities are spelled out in the contract with the insurance carrier.  Understanding your role will help facilitate referrals and financial matters. We hope you will take a few minutes to familiarize yourself with our Office Policy regarding finances and referrals.

Please call the office 24 hrs in advance if unable to keep your appointment. A $50 fee will be assessed for no-shows and same day cancellations.

Insurance Participation

We accept most insurance, please contact our office for more details.

Please be aware of your insurance’s requirements for referrals! This is one of the largest hurdles we face when working with patients that are required to obtain referrals for treatment.

Our Referral Policy – It is the patients responsibility to ensure that a valid referral is on file for the services being rendered.Referrals are usually good for 30 to 60 days depending on the carrier and in the cases of Allergy shots, some carriers will allow a global referral (up to 1 year).

Please be courteous to the Primary Care Physicians (PCP) and request the referral early as some of the offices require 3 to 7 days of advance notice. The patient may need to pick up the original referral from the PCP, however, in some cases, the PCP is willing to fax the referral to our office. We do accept faxed referrals.

Referral Policy

It is the patients responsibility to ensure that a valid referral is on file for the services being rendered. Referrals are usually good for 30 to 60 days depending on the carrier and in the cases of Allergy shots, some carriers will allow a global referral (up to 1 year).

Please be courteous to the Primary Care Physicians (PCP) and request the referral early as some of the offices require 3 to 7 days of advance notice.  The patient may need to pick up the original referral from the PCP, however, in some cases, the PCP is willing to fax the referral to our office.  We do accept faxed referrals. Please fax those to our referral line at (703) 313-7920.

Pay Bill Online

Financial Policy

• Billing inquires: can be directed to Loudoun Medial Group Billing department at (703) 443-6717 or email BillingDept@lmgdoctors.com
• Billing Department Hours are Monday – Friday 8:00am – 4:00pm
• Office charges are due and payable at the time of service.  Our Billing Office is to help facilitate insurance claims and questions you may have.  Accounts past 30 days old are considered delinquent and those at 90 days will be referred to a collection agency  for action.
• Professional services are rendered to the patient not an insurance company. Since every insurance plan is different, please be sure to check your coverage and ask questions before services are rendered. We are here to help in any way we can.
• Your insurance can deny payment for services or procedures after they are performed. We advise that you know the benefits of your individual plan.
• Payment may be made by cash, check, Visa, MasterCard, American Express, Discover, and Care Credit.
• NOTE: At this time, the full cost of the hearing aids will be due. We do not bill insurance companies for hearing aid benefits. Our Hearing Aid Company is a separate entity and does not participate with any insurance. Please call us for more information. Hearing aids can also be financed through Care Credit. You can apply for 12 months interest free financing through Care Credit at www.carecredit.com.
• The office participates in a variety of health insurance programs. If you are a participant in an insurance program that we accept, you are expected to pay your co-payment at each visit.  Failure to do so can result in action by your insurance carrier. Managed Care patients are liable for co-payments, per their carrier, and for appointments not canceled in advance.
• The Billing Office files claims for all carriers with whom we participate. Payments by the insurance carriers will be made directly to our office. They will provide you with an Explanation of Benefits (EOB) of the charges, amount covered by your policy, and payments made to our office on your behalf. Your insurance may or may not allow a portion of your bill, the remaining balance is your responsibility. If you have a secondary plan, as a courtesy, the billing office will submit the primary payment information to the secondary carrier.
• The Billing Office submits all Medicare claims for you. We also provide Medicare with your secondary insurance information. Through their crossover program, your secondary insurance will be billed directly by Medicare. Please check to see if your secondary insurance requires a signed waiver in order for this to happen. Our office will bill insurances not included in the crossover program. You are responsible for yearly deductibles, non-covered services, and co-payments when there is no secondary insurance.
• As a courtesy, the Billing Office also files claims to carriers with whom we do not participate. Payments by the insurance carriers may be sent directly to the patient instead of our office.  It is the responsibility of the patient to remit payment to our office at the time of service in these cases. If you have a secondary plan, as a courtesy, the billing office will submit the primary payment information to the secondary carrier.
• Workman’s Compensation is filed as a courtesy to our patients. However, if a claim is denied, unsettled or unpaid within 60 days, we request that you file a personal claim and pay the bill in full.  In all legal matters you are responsible for payment.
• Special consideration will be given to patients financially unable to pay in full at the time of service. Arrangements should be made in advance with the Billing Office.
• As pursuant to Virginia Law (VA Code 8.01-413) fees for copying a Medical Record are:  a search and handling fee of $15, plus $ .50 per page up to 50 pages, plus $ .25 per page for each page over 50. Example: A 62 page chart; $15 (Handling) + $25 (50 pages x 50¢) + $3 (12 pages x 25¢) = $43.00. Electronic medical records can be burned to a DVD or CD. The charge for this is $20.
• There will be a $30.00 charge for all returned checks.

Thank you for choosing Metropolitan ENT as your Healthcare Provider.