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.

How Much Will Surgery Cost?

This is a tricky question. It depends on your insurance coverage. 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 which you must meet that amount before they will cover any surgical cost. We can give you an estimate for our fees, but you may have to contact your insurance carrier and/or facility where you are having the procedure done to get all of the information related to the cost of your surgery. After surgery, it is important to know that insurance companies will process the claims in the order that they are received.  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 tell you their rates!).  And of course you likely have charges from other doctors or tests this year that have already been applied toward your deductible.  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.