Insurance at Gateway ENT in St. Louis, MO
Insurance
No one likes to talk about it, let alone deal with it. Insurance plans vary and can be complicated. While we accept most major insurance plans and are in negotiations to offer additional plans, your company may not yet have a relationship with us. If we are not on your insurance provider list, we still welcome you as our patient. It may just mean that your insurance will reimburse you but at an “out of network” amount. Some of our patients prefer to pay directly and we welcome that as well. If you have insurance or billing questions, our staff will be happy to help. Please call 314-843-3828.
How does billing my insurance work and what about co-pays?
If you plan to use insurance, we will submit your bill, but ultimately you are responsible for paying for any services received in our office, including paying the co-pay at time of service. Most insurance contracts do not allow co-pays to be billed later. If you would like us to bill your insurance company, do not forget your insurance card must be presented at the time of service.
Can I still be seen if I do not have insurance? Can I pay cash or use my credit card?
Absolutely. We will work with you to get the care you need. Patients receive a discount if they pay in full for professional services. This does not include hearing aids or other durable medical products.
If you do not have insurance, we require full payment of services at time of visit, unless you have worked out an alternative plan before your visit. We participate with Care Credit which offers payment plans. We accept most major credit cards.
Tell me about Covered or Non-Covered Services
Prior to your appointment, it is best to check with your insurance company to see if you need a referral, if services are covered, are not covered or if there is a deductible. You may call the number on your insurance card to find out any information you are unsure of. We may not be aware of your specific insurance coverage.
Unfortunately, not all services are paid by insurance. In cases where a service is not paid, you are responsible for payment. We bill your insurance first and make sure that all the information sent to the insurance company is accurate and clearly describes any services received.
Federal law requires us to submit all claims to the insurance company accurately. We are not allowed to change this information just so that the insurance company will pay the claim.
Accepting New Patients
What About a Referral?
You will need to know referral requirements from your insurance company at time of visit. Because we are specialists this is particularly important for your care. We may not be able to see you if we do not have the proper authorization.
Referrals are obtained from your Primary Care Physician who will send in the referral to your insurance company or fax it to our office. Our fax number is 314-843-3052.
Your referral should authorize any services that may be performed by the physician as well as any testing that may be indicated, such as a hearing test. Unfortunately, if we do not have your referral, you may be financially responsible for the cost of the visit.
What about coverage for hearing aids and Audiology services?
Insurance companies generally only cover hearing tests. Many, unfortunately, do not pay for hearing aids. It is important to check with your provider about hearing aid coverage or purchase allowances. A few companies have some reimbursement coverage. Gateway ENT’s Audiology division does not handle insurance submissions, but it will happily provide you with the necessary paperwork so you can submit it to your insurance. Payment plans may also be available through Care Credit.
What does it mean to be “in network” or “out of network” with Gateway ENT providers?
Being in network means that your insurance company has a reimbursement contract with Gateway ENT. Having out of network benefits means that you may still see Gateway ENT providers, but your insurance company may only reimburse part of the services you receive. If you have questions, please call our billing department at 314-843-3828
Dr Stroble performed a tonsillectomy on my 6 year old last week. He was great with our son and his staff was excellent!! They were incredibly helpful on the billing and insurance side of things and Ive always gotten through very quickly when I call. I would definitely recommend them."
Lettie, Festus MO. Review Posted On Healthgrades.com
