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New Patient Information

hank you for choosing our practice! We are committed to the success of your medical treatment and care. Please understand that payment of your bill is part of this treatment and care.

For your convenience, we have answered a variety of commonly asked financial policy questions below. If you need further information about any of these policies, please ask to speak with one of our staff.

How May I Pay?

We accept payment by cash, check, VISA, Mastercard, American Express and Discover. There is a $25 fee for all returned checks.

Do I Need A Referral?

If you have an HMO plan with which we are contracted, you need a referral authorization from your primary care physician. Referrals must be received by our office prior to the appointment. If you are unable to obtain the referral by that time, you will be rescheduled. HMO plans will not pay for a specialist visit without a referral.

Which Plans Do You Contract With?

Please see plan list.

What Is My Financial Responsibility for Services?

Your financial responsibility depends on a variety of factors, explained below. We ask that you pay any co-pays necessary at the time of check in.

Office Visits and Office Services

If You Have...	You Are Responsible For...	Our Staff Will...
Commercial Insurance Also known as indemnity, "regular" insurance, or "80%/20% coverage."	Payment of the patient responsibility for all office visits, tests, injections, and other charges at the time of office visit.	Call your insurance company ahead of time to determine deductibles and coinsurance. File an insurance claim as a courtesy to you.
HMO & PPO plans with which we have a contract	If the services you receive are covered by the plan: All applicable copays and deductibles are requested at the time of the office visit. If the services you receive are not covered by the plan: Payment in full is requested at the time of the visit.	Call your insurance company ahead of time to determine copays, deductibles, and non-covered services for you. File an insurance claim on your behalf.
HMO with which we are not contracted.	Payment in full for office visits, tests, injections, and other charges at the time of office visit.	Provide the necessary information for you to complete and file your claim directly with the insurance company.
Point of Service Plan or Out Of Network PPO	Payment of the patient responsibility — deductible, copay, non-covered services — at the time of the visit.	Call your insurance company ahead of time to determine out of network benefits, copays, deductibles, and non-covered services. File an insurance claim on your behalf.
Medicare	If you have Regular Medicare, and have not met your $100 deductible, we ask that it be paid at the time of service. Any services not covered by Medicare are requested at the time of the visit. Medicare does not pay for such items as cosmetic surgery and hearing aids. If you have Regular Medicare as primary, and also have secondary insurance or Medigap: No payment is necessary at the time of the visit If you have Regular Medicare as primary, and no secondary insurance: Payment of your 20% co-pay is requested at the time of the visit.	File the claim on your behalf, as well as any claims to your secondary insurance.
Worker's Compensation (Out of State)	Payment in full is requested at the time of the visit.	Provide you a receipt so you can file the claim with your carrier.
Occupational Injury	Payment in full is requested at the time of the visit.	Provide you a receipt so you can file the claim with your carrier.
No Insurance	Payment in full at the time of the visit.	Work with you to settle your account. Please ask to speak with our staff if you need assistance.

What if Surgery is Recommended?

If Dr. Lunde recommends surgery, you will meet our Surgery Coordinator, Erika Rubalcava, LVN. She will answer specific questions about the surgery scheduling process, discuss the paperwork and tests involved, and complete all pre-certification/authorization your insurance company requires.

The Surgery Coordinator will request a pre-surgical deposit, the amount of which depends on your coverage and deductible amount, at the time of your pre-operative appointment. The Surgery Coordinator will explain a cost estimate, which shows your financial responsibility based on the benefit levels and coverage provided by your insurance plan. Financing options are available for patients undergoing elective facial plastic surgery.

What if My Child Needs to See the Physician?

A parent or legal guardian must accompany patients who are minors on the patient’s first visit. This accompanying adult is responsible for payment of the account, according to the policy outlined on the previous pages.

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© 2003 – 2009 Kevin Lunde, MD
Board-Certified Otolaryngologist (Ear, Nose & Throat) and Facial Plastic Surgeon

Address and phone:
Baylor Medical Pavilion 1 | 4708 Alliance Blvd, Suite 780 | Plano, TX 75093
phone 972-985-FACE (3223) | fax 972-964-0562