Washington ENT Group

Insurance Participation

What is a(n)...

HMO: (Health Maintenance Organization)

There are two types of HMO's:

The first type is the Staff Model HMO. This is an organization like Kaiser Permanente. It is referred to as a Staff Model, because all of the physicians and facilities are owned by the HMO. They are not independent.

The second type of HMO is referred to as an Individual Practice Associations HMO. This type of HMO contracts with providers and facilities at specific rates to provide medical care to its members.

PPO: (Preferred Provider Organization)

A preferred provider organization is a group of providers who have come together, and negotiated their rates for treatment with various health plans. There are several national PPO organizations, but there are also many local or regional PPO organizations.

INDEMNITY POLICY

The indemnity policy is a medical policy that will allow you to go to any provider, either doctor or hospital. While the indemnity policy has the advantage of going to any provider, it usually results in either a higher premium then other types of policies, or less coverage, and maybe both.

INSURANCE PARTICIPATION

Our practice will make every effort to help you fully utilize your health insurance benefits. We will verify your participation and coverage prior to your appointment and ascertain any co-pays, co-insurances and deductibles your specific policy requires. We will request you come to your appointment prepared to pay all co-pays, co-insurances and deductibles at the time of your visit, per our agreements with your insurance company.

Please note that verification of participation and insurance benefits is not a guarantee of payment by your insurance carrier, therefore there may be other payments due once your insurance carrier has processed your claim. We will bill you for any items not covered or allowed by your insurance company once they have expedited your claim.

We encourage you to verify with your insurance carrier the full extent of your coverage prior to your visit. We also have a fully knowledgeable billing staff available to answer any questions or concerns you may have regarding our financial policies or your insurance claims.

PARTICIPATING INSURANCE LINKS:

Aetna: www.aetna.com

Alliance PPO: www.mamsi.com

Anthem BCBS: www.anthem.com

Beech Street: www.beechstreet.com

CareFirst BC/BS MD, DC: www.carefirst.com

ChoiceCare Network: www.nationalchoicecare.com

Cigna: www.cigna.com

Community Care Network (CCN): www.ccnusa.com

First Health: www.firsthealth.com

Kaiser Permanente: www.kaiserpermenente.org

Maryland Health Insurance Plan: www.marylandhealthinsuranceplan.state.md.us