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Patient Information and Online Forms

If you are scheduled for a FULL EVALUATION 
Click EACH link below and fill out each form to be submitted online securely.
If you are also having an Electocochleography Test with your Full, you will need to fill out the top 2 forms in the next section. 


If you are scheduled for an Electrocochleography test only please fill out each link.
Click EACH link below to fill out and submit online paperwork securely


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Pay Your MDBI Bill Here

Please enter the amount on the invoice you received.

On the next page, you will be prompted to enter your name and billing information. 

Insurance Definitions and Information

We accept almost all major insurances, including Medicare. While we are in network, this does not mean your insurance will cover everything we do. We are a cutting edge facility with diagnostic and treatment methods that are not universal. It is YOUR responsibility to understand your own insurance policy and limitations. MDBI falls under a specialist category. As a courtesy, we look up your coverage and try to provide you with a best ESTIMATE of what your insurance company will cover, however, your health insurance is an arrangement between you and your insurance company and the insurance company will make the final decision on coverage. 


Deductible: The amount YOU have to pay before your insurance pays anything. This typically starts over every January 1

Copay: The fixed amount you pay PER VISIT. MDBI is in the specialist category. This amount does not go towards your deductible and is in addition to it.

Co-Insurance: The percentage YOU pay after you have met your deductible, but before you reach your Out of Pocket Maximum. This ranges from 10-50% of the visit charges

Out of Pocket Maximum (OOPM): The maximum amount you have to pay for COVERED charges. This includes your copays, deductibles and co-insurance, BUT if your insurance does not cover a procedure, you will be responsible for paying for the procedure or therapy even if you have met your OOPM.


All of this information is available to you from your insurance

Medicare DOES NOT cover $250 of the Full Evaluation. This is a 3.5 hour test, and Medicare does not recognize some of the testing and treatment that we offer. It can take Medicare up to 15 years to recognize and cover new procedures. This payment is due at the time of check in. This is in addition to any Medicare deductible that has not been met for the year.


Once we have determined the cause of your symptoms, a treatment plan is put together. Medicare covers MOST but not ALL of the treatment we provide and usually there is an out of pocket expense for Medicare Treatments. This can not be determined until a diagnosis has been made. 

Some insurances require a referral or prior-authorization for our testing and treatment. We submit information for a referral to your PCP, however it is your responsibility to make sure we have this prior to your appt. If you are seen without a referral you will be required to pay the full cost since a referral is required to receive payment.

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