Insurance Plans

Advanced ENT Associates gladly accepts the open-access plans of all major health insurances (Blue Cross, Cigna, Humana, Aetna and United Healthcare).  A few HMO insurance programs still require a formal physician referral to us, which will have to be in place at the time of your visit.  We do ask you let us know who told you about us, even in the case of an informal referral.  We enjoy the opportunity to communicate back to your doctor or dentist!

There are some Closed-Network and HMO plans we do not accept, such as Medicaid, Kaiser HMO, Wellcare, Ambetter, Peachcare.  Cost-sharing or “healthcare ministry” plans are not health insurance and are treated as self-pay.  Please call and we can answer any questions you may have about coverage.

“Self-pay” or “Cash-pay” rates are available and offer a substantial discount if paid at time of service.  Often this is roughly the same rates as negotiated insurance rates if paid timely.

Update: The Northside dispute with Blue Cross does not affect our practice.  We are separate completely from Northside billing network.

Update: The Wellstar dispute with United Healthcare does not affect our practice

How Much Will Surgery Cost?

This is a tricky question.  The simplest way to think of this is “What is my deductible? And how much have I met already?”  Most insurance plans now have a deductible in place that you must spend out of pocket on tests and services before insurance starts paying.  Most surgeries will cost a few thousand dollars altogether.  Most insurance plans also have a “coinsurance” that you still owe AFTER your deductible is met. We can give you an estimate as your deductible remaining.

Example: Lets say your total healthcare CHARGES for the whole year is $20,000.  Your in-network health insurance plan will likely have network reductions on these charges to something much lower like $8,000 total.  You may have a deductible of $3,000 and a coinsurance of 20%.  In this example, you could expect your year-end out of pocket healthcare costs to be about $3,000 for the deductible then another $1000 for the coinsurance.  It is confusing though because those bills don’t hit at once and they trickles in over time, usually with a substantial delay.  There are surgeon fees, anesthesia fees, pathology fees, and surgery center fees all billed separately – all different entities which legally cannot share contract rates with each other (so WE cant even say for sure what the cost of anesthesia is!).  And of course you likely have charges from other doctors or tests this year that have already hit that deductible some.  Some people still have an ACA-non-compliant healthcare plan (pre-Obamacare plan) which amounts to a much higher deductible with more costs out of pocket.  Worse yet are the “cost sharing plans” that intentionally skirt insurance laws and are not health insurance.  These plans are cheaper every month, but there is no upper limit to your spend.  People in plans like this can rack up personal bills in the hundreds of thousands or more if disaster strikes.

We only use fully in-network surgery centers to prevent “surprise billing” issues.  Surgeries done at the hospital will cost more! The Hospital’s negotiated rates for facility and and anesthesia are 2-5X what the surgery center allows (surgeon gets paid the same).  It is more expensive to have surgery at the hospital, but is necessary for some cases. We do a handful of obscure out of network procedures, and we will let you know ahead of time if that is the case and what the charge is.