excellent. quality. CARE.

PARTICIPATING INSURANCES

 

We accept most insurances.  The list will be updated as changes occur.

 

Our current In-Network list includes:​

​

• Aetna

• Alterwood Health

• Carefirst BC/BS and Medicare Advantage

• Cigna

• Cigna Health Springs

• JAI Medical

• Johns Hopkins HealthCare (EHP/USFHP/Advantage)

• Medicare

• Medicaid MCOs

  • Aetna Better Health of Maryland

  • Amerigroup MD/DC

  • AmeriHealth Caritas DC

  • Carefirst Community Health Plan MD

  • Maryland Physicians Care

  • Medstar Family Choice MD and DC

  • Priority Partners

  • United Healthcare Community Plan (electronic referral needed)

• Medicaid - Maryland and DC

• Multiplan/PHCS

• United Healthcare (Advantage, Commercial, GEHA, UMR, MDIPA - electronic referral needed)

​

Non-Network

• Tricare as primary

​

If your insurance is not listed, please call the office to verify if we accept it.

 

Our office files claims for all insurances with whom we participate.  Payments by the insurance carriers will be made directly to our office.  They will provide you with an Explanation of Benefits (EOB) of the charges, amount covered by your policy, and payments made to our office on your behalf.  Your insurance may or may not allow a portion of your bill, and the allowable remaining balance is your responsibility. 

 

Our office submits all Medicare claims for you. Our office will bill insurances not included in the crossover program. You are responsible for yearly deductibles, non-covered services, and co-insurance when there is no secondary insurance.

​

Your insurance can deny payment for services or procedures after they are performed. We advise that you know the benefits of your individual plan.  Since every insurance plan is different, please be sure to check your coverage and ask questions before services are rendered.  We are here to help in any way we can.

​

​

​

​

​

IN-OFFICE PROCEDURES

 

• Please be aware that some procedures done in the same office visit may be considered “Surgery” by your insurance and not included in the standard office visit charges.  These procedures are billed separately and in addition to the office visit charges.  Because some insurances are classifying these as “Surgery”, they may apply the charges towards your Deductible and/or higher Co-Pay amount depending on your specific insurance benefits.  We will only know this after claims are processed by the insurance and we receive the Explanation of Benefits (EOB).  This may result in an insurance payment for the office visit but not the procedure.  In such cases, payment for the procedure will be due from the patient if it applies to the deductible or co-pay.  

​​

• Examples of In-Office Procedures include:

  • Flexible Laryngoscopy (CPT 31575): Involves passing a thin flexible fiberoptic scope through the nasal cavity and into the throat to visualize the larynx which is not readily seen otherwise.

  • Nasal Endoscopy (CPT 31231): Involves using a flexible or rigid scope to view areas of the deeper nasal cavities.

  • Nasal Endoscopy with debridement (CPT 31237): Involves removing crusting or tissue which is often performed after sinus surgery.

  • Nasopharyngoscopy (CPT 92511): Involves passing a scope through the nasal cavity to assess nasopharynx or Eustachian tubes.

  • Control of nosebleed (CPT 30901-30905): Involves different methods to stop active nosebleeds including cauterization and packing.

  • Removal of cerumen/wax (CPT 69210)

  • Audiology/Hearing tests (CPT 92550-92569)

​​

• Please feel free to check coverage of any procedures with your insurance to see if it may get applied to your deductible/co-pay.

 

***This serves as a notice to inform you of this possibility so you are not caught off guard with appropriate charges. Please be assured we are following appropriate billing and coding guidelines and all procedures are performed in the best interest of the patient to provide the highest quality care.***

​

​

​

REFERRAL POLICY

 

Please be aware of your insurance’s referral requirements. It is the patient’s responsibility to ensure a valid referral is on file for the services being rendered.  Please be courteous to your Primary Care Physician and request the referral early as some practices require advance notice.   We welcome you to call your physician and have your referral faxed to us at: 301-238-7965 or you may need to pick up the original.  Failure to have appropriate referrals on file could result in you being responsible for all visit costs incurred.

​

Thank you for helping us run a better practice!  We appreciate you for choosing ENT Professionals of Maryland!

​

​