Forms and Insurance

In order to provide the most efficient and comprehensive care to your child, please ensure the have the following items for all of your child's appointments:
• Your child’s health insurance card
• Any necessary referral/authorization number from your Primary Care Physician if required by your insurance plan (must be obtained prior to the visit)
• Co-payment (cash, check or Mastercard/Visa credit cards)
• All pertinent x-rays/scans,
• Results from any applicable diagnostic tests(hearing test, sleep studies, etc)
• Inform us of any changes in insurance, address, pediatrician
• NEW PATIENTS- must complete Intake Form below

Cancellations- please notify us as soon as possible if you need to cancel or change your scheduled appointment. A $50 No Show Charge will be applied to your account if you do not notify us of a cancellation (24 hours prior to appointment).


Patient Forms



Insurance Information

We accept all major insurances.

If a particular insurance is not listed, please give our billing office a call to see if we are able to accommodate your child (203-245-0496, x106 or 107)


Connecticut Pediatric Otolaryngology does participate with most insurance carriers in Connecticut, however please ensure we accept your insurance prior to your visit. We make every effort to coordinate payment for your visit with your insurance carrier. However, you must provide us with accurate, up to date information which will assist in the collection process. All claims that are denied by the insurance carrier are the responsibility of the patient and parent/guardian.


Billing Issues with Surgery at Connecticut Pediatric Otolaryngology

When you schedule surgery for your child with any of the doctors at Connecticut Pediatric Otolaryngology, the billing can be confusing. This letter is designed to clarify our policy.

Three groups need to be paid whenever a patient has surgery: (1) the surgeon, (2) the anesthesiologist and (3) the facility (the place where the surgery occurs). Your benefits though your insurance carrier will determine how much of each fee they will cover and how much you will be responsible to pay out of pocket.

Connecticut Pediatric Otolaryngology (the doctors' office) will bill your insurance company for the surgeon's fee, and will bill you directly for the remaining portion that you are responsible for. In addition, the facility where the surgery takes place (either Yale-New Haven Hospital or North Haven Surgery Center) will bill your insurance company for their fee. Lastly, the anesthesia provider will also bill your insurance company and will bill you for any remaining portion that is owed them. The doctors' office, surgery center and the hospital all accept checks and credit cards and have dedicated billing offices that are available via phone during business hours to answer any questions that you may have.

Again, please understand that you may receive up to 3 separate bills.

We are required to disclose that Dr. Karas and Dr. Baum have an ownership interest in North Haven Surgery Center, but this fact does not change any of the billing or payment arrangements and does not affect the amount that either you or your insurance company will have to pay for any of the services provided.

Like most medical practices, we would rather concentrate on providing the very best care for your child instead of dealing with all this stuff, and we're sure you would too. Please contact any of us early in the process so we can help clear up any of the financial details. Then we can all focus on the health of your family.

Billing Office Phone Numbers
Connecticut Pediatric Otolaryngology (203) 245-0496
North Haven Surgery Center (203) 234-7727
Bridgeport Anesthesia Group (203) 348-3174
Yale-New Haven Children's Hospital (203) 688-4242