7447 W. Talcott, Suite 316
Chicago, Illinois 60631
(773) 467-1285
(866) 777-2159

800 Biesterfield Road, Suite 401
Elk Grove Village, Illinois 60007
(847) 357-9486
(866) 777-2160

Patient Resources - About Your Visit

Northwest ENT Associates makes every effort to accommodate patients with appointments. We will call you the day before your visit to confirm your appointment.


New Patients

Please arrive ½ hour prior to your visit if you are a new patient with your completed registration forms, insurance card, picture ID, name of your primary care physician, name and location of your pharmacy and a medication list. Having this information ready and with you will expedite the registration process and make your visit go smoothly.

Patient Forms

HIPAA Notice of Privacy Practices

New Patient Information

Medical History Form

Post Operative Instructions


Established Patients

Please arrive prior to your appointment time to allow adequate time to verify insurance coverage and make any necessary changes to update your insurance. If it has been six months or more since your last visit, we will ask you to update your health history and any medications and fill out any necessary registration forms.

If you arrive very early for your appointment, we will try to get you in sooner if at all possible.

If you arrive past your appointment time, it is up to the Doctor’s discretion whether you will be seen or be asked to reschedule.

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Cancellations

If you have to cancel your appointment, please notify us as soon as possible. This is to insure that available appointment slots are open to other patients.


No Shows

You may be charged a no show fee of $25 if you do not call to cancel your appointment. This will be determined by the Physician with whom you had the appointment.


Missed Appointments

Patients who miss appointments on a regular basis may be discharged from the practice.

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Billing and Insurance Information

Insurance information

We are contracted with most major insurance carriers. However, it is the patient’s responsibility to verify with their insurance company that the provider is in network and contracted with that particular plan. It is the responsibility of the patient to bring the appropriate referral or authorization number if the insurance is an HMO. Please contact us if you have any questions.

Copays and Past Due amounts

We ask for copays at the time of service. If there is any past due amount, it will be requested at the time of service. If you cannot pay the past amount at the time of the appointment, you must contact the Practice manager to set up a payment plan.

Medicare

We do accept Medicare assignment.

Medicaid

We do not see Medicaid patients unless they have been referred by the Emergency Room at Alexian Brothers Medical Center or Resurrection Medical Center and have papers from ER to verify the referral.

Self-Pay

We do see self-pay patients with the exception of Dr. Thomas Garrity. The patient is expected to pay at the time of service.

Billing

We will submit electronically to your insurance company. In order to do that, we will need the insurance card with the subscriber name, date of birth, policy ID and group number. The claim address must be clearly displayed. You are responsible for any co-insurance or deductible amounts per the Explanation of Benefits we receive from your insurance company once the claim has been adjudicated.

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