Puget Sound Ear Nose & Throat, a division of Proliance Surgeons, is committed to providing you with the highest quality medical care. Because patients are ultimately responsible for the charges associated with their care, even when insurance is in place, you may find the following information helpful. We realize you have choices for your medical care and appreciate your choosing Puget Sound Ear Nose & Throat.

Patient Responsibilities

You can help ensure an efficient experience by assisting with the following:

  • Providing us with your picture identification and insurance card to enable us to submit your claims timely and accurately
  • Knowing your insurance benefits and limitations
  • Ensuring there is an authorization for our providers to treat you if it is required by your insurance, including obtaining a referral
  • Providing us with copies of any pertinent medical records, including tests (MRI/CT/Arthrogram) and x-rays
  • Paying your estimated portion of the charges at the time of service
  • Paying any additional amount owed when due
  • Completing required incident/accident forms within 30 days of date of service
  • Maintaining a current account with Proliance Surgeons at all times
  • Providing us with at least 24 hours advance notice should you need to cancel or reschedule an appointment

Please note that co-payments, co-insurance and deductibles are a contractual agreement between you and your insurance carrier. We cannot change or negotiate these amounts.

Insured Patients

We will bill your primary and secondary insurance carrier in a timely manner. If you are disputing payment with your insurance carrier or have a balance over $100.00 with us, you must notify our business office and make payment arrangements.

Co-Pays/Deductibles/Co-Insurance: Please be prepared to pay for your portion of the charges on the date of service.

Non-Participating Insurance: If we do not participate in the insurance you have, we will file a claim as a courtesy. All unpaid claims will become your responsibility 45 days following filing and be immediately due and payable.

Uninsured Patients

Visits: A $200 deposit is required prior to the appointment. If visits and services are paid in full at the time of service, we offer you a 20% discount (see exclusions below). Office visits may include scopes uses for diagnostic purposes, hearing tests, biopsies, excisions of lesions, insertion of ear tubes, which are charged separately from the office visit. Charges are not finalized until chart notes are complete.

Surgery: For uninsured patients having surgery, we offer a 20% discount when charges are paid before or on the day of service (see exclusions below).

Exclusions: The discounts referenced above do not apply if case of motor vehicle accidents, third party insurance claims or in other cases when the patient may be reimbursed in full. Private pay patients who receive retroactive Medicaid coverage need to immediately notify our business office.

Motor Vehicle Accidents (MVA) Insured and Third Party Patients

We do not extend discounts for MVA-insured accidents, third party insurance claims or in other cases when patients may be reimbursed in full. We will bill the MVA insurance carrier one time. The bill becomes your responsibility if not paid by the carrier in 30 days. We regret that we are not in a position to confer with attorneys or defer payment obligations while a case settles. If your personal injury protection benefit on your MVA policy is exhausted, we will bill your private insurance at your request provided we are furnished the necessary information at the date of service.

Workers’ Compensation

If your visit is work-related, we will need the case number and carrier name prior to your visit in order to bill the workers’ compensation insurance carrier. If your workers’ compensation claim is not yet accepted and you have no other insurance, we require a $200 deposit that will be refunded after the claim has been opened.

Other Charges

No Show: Please provide us with at least 24 hours advance notice if you need to cancel or reschedule an appointment. We may charge a fee for missed appointments. Please provide us with at least 48 hours advance notice if you need to cancel or reschedule an appointment and an interpreter has been scheduled. Otherwise, you may be charged for the interpreter.

Forms: There may be a charge associated with our completion of some forms. We require payment of the charge before returning the completed form to you. A signed Release of Information may also be necessary. Please allow five business days for us to complete forms.


Payment Options: We accept cash, checks $200 and under, major credit/debit cards and money orders for payment (no postdated or third party checks). We charge a $40.00 NSF fee for any returned checks.

Delinquent Accounts: We charge a $10.25 monthly account management fee on balances over 45 days old. We may assign an account to collections if balances are unpaid after 60 days. Patients assigned to collections may be denied additional service.

Alternative Payment Arrangements: If you are unable to pay your balance when due, please contact our business office to make alternative arrangements. Any patient with a past due amount may be denied additional service until the amount is paid or the patient is complying with an alternative payment arrangement.

Bankruptcy/Prior Bad Debt: Patients who have previously filed for bankruptcy or never satisfied their payment obligations for prior episodes of care with Puget Sound ENT or other Proliance Surgeons care centers may be required to pay for their portion of new charges at the time of service.


Thank you!

Our office will add this to your file.

The best patient care is put into practice every day at Puget Sound ENT — we consider it a privilege to serve you.

76th Professional Commons
21911 76th Ave W
Suite 211
Edmonds, WA 98026

Fax: (425) 670-6718
Alt Fax: (425) 670-6719
1 (425) 775-6651 Directions
Mill Creek

Swedish Mill Creek Medical Center
13020 Meridian Ave S, 2nd Floor
Everett, WA 98208

Fax: (425) 670-6718
Alt Fax: (425) 670-6719
1 (425) 337-4810 Directions

Ear Nose Throat & Allergy Associates
104 27th Ave SE
Puyallup, WA 98374

*Dr. Backous only

1 (253) 770-9000 Directions
Edmonds Center for Outpatient Surgery (ECOS)

Edmonds Medical Pavilion
7320 216th Street SW, Suite 140
Edmonds, WA 98026

1 (425) 673-3750 Directions