Billing Information

At the Werner Institute of Balance and Dizziness, Inc. we realize your health care experience is not limited to just a clinic visit or therapy appointment. Our billing department is committed to making your financial experience as simplistic and convenient as your clinical one.

Our online billing guide can help you with:

• Frequently asked billing questions
• Cash payment policies and costs
• Billing Terms Glossary

If you have any questions, or need help in any way, please contact:

Juliann Alaniz
Billing/Office Administrator
julianna@nomorevertigo.com
(702) 880-1515

Laura Millen
Billing Specialist
lauram@nomorevertigo.com
(702) 880-1515

Rose Workman
Biller
rosem@nomorevertigo.com

back to top

Billing Frequently Asked Questions

If you need additional information, please contact the Billing Department at (702) 818-5000.

I received a billing statement. How do I know my insurance company paid its portion?
If you have any questions about your insurance payment, please call your insurance company directly. The insurance company's phone number is usually printed on the back of your insurance card.

When do I pay the co-payment?
We will always pre-authorize your insurance before coming to see us. Your co-payment is due at the time of your appointment. If you are unsure of your co-pay responsibilities, please look at your insurance card, or call your insurance company.

What if I forget to bring my insurance information to my appointment?
You will be registered as self-pay during scheduling, which means you are responsible for paying the entire bill. You should call the receptionist immediately at (702) 818-5000 after you get home to provide your insurance information, or you will be billed as self-pay.

How does my insurance company receive the claim for health care services?
WIBD files the claim with your insurance company. To insure prompt, proper claim processing, please verify that we have the proper insurance information on file when you schedule your appointment.

Why are some of my bills from WIBD covered by my insurance, while others are not covered?
Benefit plans and coverage can change every year and will determine whether or not a patient's bill is covered by insurance. It is not uncommon for healthcare coverage to have a deductible or out-of-pocket expense. Since each plan can be different, we encourage patients to carefully review their benefits with their insurance company.
 
I received a letter stating my account has been referred to a collection agency or collection attorney. Why was this done and what should I do?
Prior to an account being placed with collections, patients should receive three billing statements from WIBD advising them of their account activity. They may also receive phone calls from WIBD's billing office personnel during this billing period. After these steps have been taken and payment or payment arrangements have not been made, the account is then referred to collections. These agencies act as a branch of our billing department and therefore act under the direction of WIBD.  Once an account is placed with an outside agency, we ask that patients work directly with the agency to resolve the balance. We hope this lessens confusion and frustration by eliminating unnecessary phone calls for patients.

back to top

Billing - Cash Pay Costs and Policies

The costs for services at WIBD vary by the type of evaluation being performed.

A. Comprehensive Balance/Dizziness Evaluation - Patients who have these orders will see:

1. Initial evaluation
2. Diagnostic testing in our balance lab
   Approximate total cost = $400 with 20% cash discount

B. Diagnostic Balance/Dizziness Evaluation Only - Patients who have these orders will see:

1. Diagnostic testing in our balance lab with all tests performed
   Approximate total cost = $

So, depending on the type of treatment you will be receiving at WIBD will determine the total costs of your treatment. The prices below reflect a 20% cash discount from our fee schedule. This discount is only given for a patient if they pay the same day as their appointment or make prior arrangements before their scheduled appointment. The prices for services performed below are for the typical services billed for that type of appointment. These ARE NOT guaranteed amounts and could be higher or lower depending on what exactly is performed.

Diagnostic Testing Procedures

NOTE: The diagnostic testing procedures above are the typical battery of tests necessary for most patient's to properly diagnose their condition. The total cost may be lower based upon the initial diagnosis of the doctor and the tests deemed required by our audiologist during the actual exam. This would be considered the high cost for the exam.

Physical Therapy Services
Physical therapy Evaluation $150
Physical Therapy Re-Evaluation $120
Each Physical therapy treatment sessions $120
Each Near Infrared (NIR) treatment is $13.50/hr

back to top

Billing Terms Glossary

At WIBD, we realize patients are not always familiar with the terminology we use with reference to the billing process. This is a list of commonly-used billing terms and their definitions that will help guide you through the process.

Allowed Expenses - The maximum amount a plan pays for a covered service. See Usual and Customary Charges

Assignment - a process under which Medicare pays its share of the allowed charge directly to the physician or supplier. Medicare will do this only if the physician accepts Medicare's allowed charge as payment in full.

Beneficiary - someone who is eligible for or receiving benefits under an insurance policy or plan.

Beneficiary Liability - the amount beneficiaries must pay for covered services. These include co-payments, coinsurance, deductibles and balance billing amounts.

Billing Statement - Summary of patient account activity that is sent to patient regarding the status of their claim.

Certificate of Coverage (COC) - A description of the benefits included in a carrier's plan. The certificate of coverage is required by state laws and represents the coverage provided under the contract issued to the employer.

Claim - The information billed to the insurance company for services provided to the patient.

Co-insurance - a type of cost sharing where the beneficiary and insurance provider share payment of the approved charge for covered services in a specified ratio after payment of the deductible by the insured. For example, for Medicare physicians' services, the beneficiary pays co-insurance of 20 percent of allowed charges.

Consolidated Omnibus Budget Reconciliation Act (COBRA) - A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated. Applies to employers with 20 or more eligible employees. Typically, COBRA makes continued coverage available for up to 18 or 36 months. COBRA enrollees may be required to pay 100 percent of the premium, plus an additional 2 percent.

Coordinated Coverage - Integrating benefits payable under more than one health insurance (for example, Medicare and retiree health  benefits). Coordinated coverage is typically arranged so the insured benefits from all sources not exceding 100 percent of allowable medical expenses. Coordinated coverage may require beneficiaries to pay some deductible or co-insurance.

Coordination of Benefits (COB) - a provision that applies when a person is covered under more than one group medical program. (See "Coordinated Coverage" above.)

Co-payment – (1) A fixed dollar amount paid for a covered service by a beneficiary (See Co-insurance and Deductible). (2) Amount that a member of a health plan has to pay for specific health services, such as visits to a physician. (See "Beneficiary Liability" and Co-insurance" above.)

Contractual - The difference between the insurance contracted amount and the amount of the charge.

Co-payment or Co-insurance - The fee per visit paid by the patient for health-care services as determined by your medical insurance policy.

Date Of Service (DOS) – the date(s) healthcare services were provided to the beneficiary.

Deductible – (1) The amount the patient pays for medical care before insurance covers the balance. (2) A type of cost sharing where the beneficiary pays a specified amount of approved charges for covered medical services before the insurer will pay for all or part of the remaining covered services. (3) Total amount a member of a health plan has to pay for services before that person's plan begins to cover the costs of care. (See "Beneficiary Liability" above.)

Experimental Procedures - Any health care services, that are determined by the insurance plan to be either; not generally accepted by informed health care professionals in the United States as effective in treating the condition, illness or diagnosis for which their use is proposed; or not proven by scientific evidence to be effective in treating the condition for which it is proposed.

Employee Retirement Income Security Act of 1974 (ERISA) –This law mandates reporting, disclosure of grievance and appeals requirements and financial standards for group life and health. Self-insured plans are regulated by this law.

Enrollee - person who is covered by health insurance.

Explanation of Benefits (EOB) – the coverage statement sent to covered persons listing services rendered, amount billed and payment made. This normally would include any amounts due from the patient, as described in "Beneficiary Liability," "Co-insurance," "Deductible" and "Co-payment" all listed above.)

Financial Assistance - Adjustments made for qualified responsible parties, based on financial assistance applications and established financial guidelines.

Guarantor -The parent or guardian responsible for paying the bill.

Health Care Provider – an individual or institution that provides medical services (e.g. a physician, hospital or laboratory). This term should not be confused with an insurance company that "provides" insurance.

Health Insurance – coverage that provides for the payment of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment.

Health Insurance Portability and Accountability Act (HIPAA) – A federal law intended to improve the availability and continuity of health insurance coverage that, among other things:

1. places limits on exclusions for pre-existing medical conditions;
2. permits certain individuals to enroll for available group healthcare coverage when they lose other health coverage or have a new dependent;
3. prohibits discrimination in group enrollment based on health status;
4. guarantees the availability of health coverage to small employers and the renewability of health insurance coverage in the small and large group markets;
5. requires availability of non-group coverage for certain individuals whose group coverage is terminated.

Health Maintenance Organization (HMO) - an entity that provides, offers or arranges for coverage of designated health services needed by plan members for a fixed, prepaid premium.

Home Health Agency (HHA) – a facility or program licensed, certified or otherwise authorized according to state and federal laws to provide healthcare services in the home.

International Classification of Diseases, 9th Edition (Clinical Modification) (ICD-9-CM) – a listing of diagnosis and identifying codes used by physicians and hospitals for reporting diagnoses and procedures of health plan enrollees.

Managed Care - A medical delivery system that manages the quality and cost of medical services.

Maximum Out of Pocket - The most money you can expect to pay for covered expenses. The maximum limit varies from plan to plan. Once the maximum out-of-pocket has been met, the health plan will pay 100% of certain covered expenses.

Medicaid – (1) A state/federal benefit program for the poor who are aged, blind, disabled or members of families with dependent children. Each state sets its own eligibility standards. Only 40 percent of individuals with income below the poverty level currently are covered.

Medicare – A federal health benefit program for people over 65 and disabled that covers 35 million Americans—or about 14 percent of the population—for an annual cost of over $120 billion. Medicare pays for 25 percent of all hospital care and 23 percent of all physician services.

Medicare Assignment – see Assignment.

Medicare + Choice – a program created by the Balanced Budget Act of 1997. Beneficiaries will have the choice during an open season each year to enroll in a Medicare + Choice plan or to remain in traditional Medicare. Medicare + Choice plans may include coordinated care plans (HMOs, PPOs or plans offered by provider-sponsored organizations); private fee-for-service plans or plans with medical savings accounts.

Medicare Supplement Policy (Medsupp) – the insurer will pay a policyholder's Medicare co-insurance, deductible and co-payments for Medicare Part A and B and may provide additional supplement benefits according to the supplement policy selected. Also called Medigap of Medicare wrap.

Medigap Insurance – privately purchased individual or group health insurance policies designed to supplement Medicare coverage. Benefits may include payment of Medicare deductibles, co-insurance and balance bills, as well as payment for services not covered by Medicare.

Medigap Plan – purchased by Medicare enrollees to cover co-payments, deductibles and healthcare goods or services not paid for by Medicare. Also known as a Medicare supplements policy.

Medigap Policy – a privately purchased insurance policy that supplements Medicare coverage.

Non-Participating Provider (Non-par) – Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of health care.

Out of Network (OON) – coverage for treatment obtained from a non-participating provider. Typically, it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider.

Out-of-Pocket-Costs/Expenses (OOPs) – the portion of payments for covered health services required to be paid by the patient, including co-payments, co-insurance and deductible. (See "Beneficiary Liability," "Co-insurance," "Deductible" and "Co-payment" above.)

Part A Medicare – Medical Hospital Insurance (HI) under part A of title XVIII of Social Security Act, which covers patients for inpatient hospital, home health, hospice and limited skilled nursing facility services. Beneficiaries are responsible for deductibles and co-payments.

Part B Medicare – Medicare Supplement Medical Insurance (SMI) under Part B of Title XVII of the Social Security Act, which covers Medicare beneficiaries for physician services, medical supplies and other outpatient treatment. Beneficiaries are responsible for monthly premiums, co-payments, deductibles and balance billing.

Payment Arrangements - A formal payment plan set up with Customer Service when the balance due cannot be entirely paid by the due date.

Payor - A third party entity (commercial or government) that pays medical claims.

Point-of-Service Plan (POS) – a health benefit plan allowing the covered person to choose to receive a service from a participating or non-participating provider, with different benefit levels associated with the use of participating providers.

Pre-existing Condition (PEC) – any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage. Pre-existing conditions may not be covered for some specified amount of time as defined in the certificate of coverage (usually six to 12 months). Individuals can be required to satisfy a pre-existing waiting period only once, so long as they maintain continuous group health plan coverage with one or more carriers.

Pre-existing Condition Exclusion – a practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated.

Preferred Provider Organization (PPO) – a program that establishes contracts with providers of medical care. Providers under such contracts are referred to as a preferred provider. Usually, the benefit contract provides significantly better benefits and lower member costs for services received from preferred providers, thus encouraging covered persons to use these providers.

Premium – (1) Amount paid periodically to purchase health insurance benefits. (2) The amount paid or payable in advance, often in monthly installments, for an insurance policy.

Prevailing Charge - What determines a physician's payment for a service under the Medicare payment system.

Prior Authorization / Precertification - A formal approval obtained from the insurance company prior to delivery of medical services. Many insurance companies require prior authorization or precertification for specific medical services.

Reasonable and Customary (R & C) – a term used to refer to the commonly charged or prevailing fees for health services within a geographic area.

Secondary Insurance – any insurance that supplements Medicare coverage. The three main sources for secondary insurance are employers, privately purchased Medigap plans and Medicaid.

Skilled Nursing Facility (SNF) – a facility, either free-standing or part of a hospital, that accepts patients seeking rehabilitation and medical care that is less intense than that received in a hospital.

Sub-Acute Care – usually described as a comprehensive inpatient program for those who have experienced a serious illness, injury or disease, but who do not require intensive hospital services. The range of services considered sub-acute can include infusion therapy, respiratory care, cardiac services, wound care, rehabilitation services, post-operative recovery programs for knee and hip replacements, cancer, stroke and AIDS care.

Subscriber - The person who holds and / or is responsible for the medical insurance policy.

Third Party Administrator (TPA) – an independent person or corporate entity (third party) that administers group benefits, claims and administration for a self-insured company or group.

Usual, Customary and Reasonable (UCR) – a term used to refer to the commonly charged or prevailing fees for health services within a geographic area.

Utilization Review (UR) – a formal assessment of the medical necessity, efficiency and/or appropriateness of healthcare services and treatment plans on a prospective, concurrent or retrospective basis. 

back to top