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:

  • Medicare + HMOs: Humana Medicare PPO
  • Railroad Medicare
  • VA Medicaid + HMOs: VA Premier, Anthem Healthkeepers Plus, Anthem Healthkeepers YTH (requires referral)
  • “WV Medicaid + HMOs: Unicare of WV (requires referral from PCP listed on the card), PAAS (requires referral from PAAS provider listed on the card)
  • Tricare Standard (non-network) (doesn’t require referral)
  • Tricare Prime (requires referral from primary care physician)
  • Anthem BCBS and BCBS Federal
  • Mt. State BCBS
  • Cigna (PPO/HMO/POS) / Great-West Healthcare
  • PEIA-Public
  • SIPA Plans: ***SIPA provider to SIPA provider no referrals needed from PCP**
  • Aetna PPO (Aetna HMO requires referral)
  • UHC/Mamsi/MDIPA (HMO/PPO)
  • OneNet PPO (f/k/a Alliance)
  • Community Health
  • Optima Health (commercial and commercial HMO (referral is not required for HMO))
  • WVUH East cards ONLY (Health Partners Network)
  • AmeriHealth
  • Physician Services (4Most)
  • Perdue Farms
  • Primary Physicians Care/Wells (Southeast Container)
  • VHN (includes Mid-Atlantic Regional Council of Carpenter’s Health)
  • Sysco Foods
  • nHealth – effective 4/15/2010
  • Acordia/Wells Fargo
  • Virginia Workman’s Compensation
  • Innovation Health

**Aetna list of participating products:

  • Aetna Choice POS II (Aetna Health Fund)
  • Aetna Choice POS II (Open Access)
  • Aetna Open Access Elect Choice EPO (Aetna Health Fund)
  • Aetna Open Access Managed Choice POS (Aetna Health Fund)
  • Aetna Select (SM)
  • Aetna Select (SM) (Open Access)
  • Elect Choice EPO
  • Elect Choice EPO (Open Access)
  • Managed Choice POS
  • Managed Choice POS (Open Access)
  • National Advantage Program (ie. NAP)
  • Open Access Aetna Select (SM) (Aetna Health Fund)
  • Open Choice PPO
  • Open Choice PPO (Aetna Health Fund)

Aetna Signature Administrators
*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