Insurance & Fees

Policies, Insurance, and Billing

There are a few policies to be aware of when being seen at Winchester ENT:

  • Payment is required at the close of the appointment.
  • Copays are due prior to being seen, patient will not be seen without paying copays if their insurance requires them.
  • Our office submits claims electronically and may know your patient responsibility balance prior to you receiving a statement. Our office reserves the right to update you based on your insurance’s payment and your patient responsibility. We may ask while you are in our office to pay on your account.
  • 24 hr confirmation calls, email and text reminders will be made to remind you of your appointment. If you fail to show for your appointment and do not give 24hr notification a $25 fee will be charged to your account and you will not be able to be seen until it is paid. If you are scheduled with the Audiologist an additional $50 charge will be assessed.
  • If you no show for an office surgical procedure and do not call before 24hrs you will be charged $50. If you are a no show for a hospital surgery and fail to cancel within 24 hrs a $155 fee will be charged.
  • All hospital surgery cancellations require a minimum 5 day business notification and failure to notify office in sufficient time will result in a $155.00 fee charge.
  • Failure to pay your balance in full in 30 days will be subject to finance charge. Failure to pay your balance within 90 days will result in your account being turned over to collections. We will attempt to communicate with your insurance; however, it is ultimately the patient’s responsibility for all fees incurred.
  • Patients without insurance will be required to pay a $160 prior to being seen. This may or may not cover full charges. You will be required to pay the balance at your exit. Before procedures are performed you will be informed of the price.
  • Prescriptions will be given at the time of your appointment. The office will not call in or fax in refill prescriptions without a patient being seen. Please remember to ask for any refill at the time of your visit.
  • Returned Bank Check charge is $25.00.
  • All current balances must be paid in full prior to the scheduling of a surgical procedure. Our office also reserves the right to collect half the patient’s out of pocket expense prior to the scheduling of any procedure.

Insurance & Fees

The following is the list of insurances with which we participate. This will be updated from time to time as needed:

  • Aetna Commercial/Medicare
  • Anthem BCBS
  • Apostrophe
  • Cigna Healthcare
  • Department of Labor – Black Lung Program
  • Department of Labor – Energy Program
  • Department of Labor – FECA Program
  • HealthNet Federal Services (HNFS) Tricare
  • Humana
  • Medicare – Palmetto – VA Re-validation
  • Medicare – Palmetto GBA – VA
  • Multiplan/PHCS
  • Railroad Medicare Virginia
  • United Healthcare
  • Virginia Health Network
  • Virginia Medicaid

*Medicaid participation is optional and varies amongst Privia Medical Group providers – please verify participation prior to your visit.

Note: You should always check with your Privia Medical Group provider to verify plan and product coverage as this is not an exhaustive list, and plans change frequently.

Payment Options

We accept cash, Visa, Mastercard, Discover, American Express, and personal checks.

Card-on-File

We encourage patients to keep a credit card on file to make the checkout process easier, faster, and more efficient. You will no longer receive statements from us, but you will continue to receive your Explanation of Benefits (EOB) from your insurance carrier once your claim has been processed, detailing the charges and payments made on your behalf.

At check-in we will:

  • scan the credit card of your choice, including your Flexible Spending Account (FSA) or Health Savings Account (HSA) card

After your insurance has paid their portion, we will:

  • notify you via email of the balance owed
  • charge the balance owed to your card on file
  • email a receipt for the charge

Your credit card information will always be fully protected by our off-site, card-processing partner Elavon, and not on our computers, as required by industry standards (Payment Card Industry Data Security Standard – PCI-DSS).

Fees

No Shows
Missed Appointment (No 24-hour notice) $25
Missed office Surgical Procedure (No 24-hour notice) $50
Hospital surgery cancellations (without a minimum of five days notice) $155
Returned check $25
Out-Of-Network
New Patients Total Charge
New Patients with no insurance  $160 charge due prior to being seen

Additional Resources

Avoiding Surprises in Your Medical Bills

Avoiding Surprises in Your Medical Bills (Spanish)

Understanding Healthcare Prices: A Consumer Guide

Understanding Healthcare Prices: A Consumer Guide (Spanish)

Planning For a Medical Procedure