Insurance, fees and Payment

Our staff is committed to helping you understand and fulfill your insurance requirements so that you can get the medical attention you need. We work with a number of health insurance plans, as well as Medicare. If you do not have health insurance, our staff will assist you in making arrangements based on your financial situation.

Office Visit Co-Insurance
Payment is expected at the time of service. For your convenience, we will calculate the estimated patient co-insurance or co-pay. Estimates are based on our contracted rate with your insurance company and your specific plan benefits. We will bill your insurance and will notify you if there is an additional balance due or credit in your favor.

Managed Care & Traditional Insurance
OHSU Medical Group will submit insurance claims for medical and surgical services. We do rely on you, the patient, for the most up to date information regarding your coverage so we can bill correctly. If you are on a plan that requires authorization from your primary care physician, we require the referral or authorization number at the time of service in order to submit your insurance claim for payment. Without a referral or authorization from your primary care physician, your insurance benefits may be reduced or denied.

Plans with reduced benefits for OHSU.
Certain insurance plans allow patients to seek care outside the plan's preferred physician panel at a reduced benefit. For example the plan pays 80% for preferred physician services and 60% for all other physicians. Please check with your insurance to ensure that OHSU is on your in-network panel.

If you do not have insurance
Patients without medical insurance are requested to pay at the time of service. We will require a deposit at each appointment. You will receive a statement from the Medical Group with your remaining balance.

Surgery
All of our physicians are surgeons. After seeing you, the doctor may determine that you need surgery. We will partner with you to obtain approval from your insurance carrier for your surgery. We urge you to contact your insurance carrier to learn of your benefits as soon as possible. If you have a deductible that is not met or your insurance reimburses at a lower than average rate, we will ask for a partial payment on your surgery up front. If the total of your deposit and any insurance payments results in a credit balance, we will issue you a refund.

Flat Fee For Cosmetic Surgery
Our facial plastics doctors perform cosmetic surgery on a flat fee basis. A flat rate is an inclusive price for surgeon, hospital and anesthesia. Cosmetic procedures are not payable by insurance.

In Office Procedures
Please be advised that during your visit the doctor may need to perform an in-office procedure. This can include the use of a scope to look at your nasal passages or your throat. We utilize the most advanced technological methods to diagnose and treat ear, nose, and throat disorders. The procedures we employ as part of your evaluation ensure an accurate and thorough exam.

Depending on the nature of your condition, the in-office procedure (such as an endoscopy) may be diagnostic and used strictly for visualization purposes. At other times, the procedure may be used for surgical purposes to clean an area or to remove a polyp or mass. In some instances, the doctor may take a picture of the exam/procedure site for additional study and review.

These procedures are medically necessary for the doctor to accurately diagnose your condition. Employing the use of these exams and procedures is the standard of care for providing complete and comprehensive otolaryngology services in an office setting. The doctor may also recommend a CT scan or other diagnostic testing, together with the endoscopy, to provide more information about your condition.

Insurance companies will consider all of these procedures "surgical". We do not have control over how endoscopies are interpreted by insurance companies. Diagnostic endoscopies are always considered "surgical", despite the fact that surgical instruments are not used. We notify you of this issue in advance so you are not surprised when you receive an explanation of benefits from your insurance company that states a "surgical service" was provided. Also, surgical services may be reimbursed or paid at a different rate than an office visit.

If you have any questions about our office policy, please contact our Financial Counselor at 503 418-5069