Insurance & Financials

PARTICIPATING INSURANCES

• Aetna
• Blue Cross Blue Shield of Maryland
• CareFirst Administrators
• Cigna
• Coventry National Network (not of Delaware)
• First Health Network
• Johns Hopkins EHP
• Johns Hopkins US family health plan (Participating, not preferred)
• Mail Handlers
• Medical Assistance State of Maryland
  • Medical Assistance MCO – Priority Partners
  • Medical Assistance MCO – United Healthcare (Community Plan; Requires online referral by Primary care provider)
  • We do NOT participate with any other Medical Assistance Plans
• Medicare
• PHCS/Multiplan
• Tricare Prime
• Tricare North
• Tricare for Life
• United Healthcare

NO SURPRISES ACT

The federal No Surprises Act became effective Jan. 1, 2022. The law aims to help patients understand
health care costs in advance of care and to minimize unforeseen or surprise medical bills.
The Centers for Advanced ENT CARE has created this guideline to help you prepare and understand
your health care costs. For your immediate reference, our website provides a list of plans that we are
currently In Network with under the Insurances section.

Overview

• What is balance billing/ surprise billing?
Your plan may assign an out-of-pocket responsibility for when you see a doctor or other health care
provider. Because of this, you may owe a copay, coinsurance and, or, a deductible. Your responsibility
might increase when you visit a provider or facility that is outside your plan’s network.
Balance Billing occurs when Out of Network providers bill you for the difference between “what your
plan agreed to pay and the full billed amount. Surprise Billing is an unexpected balance bill.
• How are Patients Protected?
For certain scheduled care with out-of-network providers, patients must be given advance notice and
give approval, where applicable, to be billed for any related out-of-network fee or amount.
Patients are protected from balance billing resulting from emergency services and for certain
scheduled services at an in-network hospital or ambulatory surgery center.
Self-Pay Patients, patients without insurance or who do not wish to use their plan for coverage of
services, have a right to receive a good faith estimate of their potential bill for medical services when
scheduled at least three days in advance.
Individuals with Medicare, Medicare Advantage, Medicaid, Indian Health Services, VA health care, or
TRICARE insurance plans are not covered under the No Surprises Act because these federal insurance
programs have existing protections in place to minimize large, unforeseen bills.
• Why do we care?
The No Surprises Act will reduce instances where patients face unexpected medical bills due to
receiving care from an out-of-network facility or provider during an emergency. Similarly, patients are
protected from receiving surprise bills for certain scheduled services for which they could not
reasonably know the network status of a provider.

Maryland Specific Balance Billing Protections

Patient enrolled in a health maintenance organization (HMO) governed by Maryland law, may not be
balance billed for services covered by their plan, including ground ambulance services.
Patient enrolled in a preferred provider organization (PPO) or exclusive provider organization (EPO)
governed by Maryland law, hospital-based or on-call physicians paid directly by the PPO or EPO
(assignment of benefits) may not balance bill for services covered under the patient’s plan, and they
cannot ask them to waive their balance billing protections. If a patient uses ground ambulance
services operated by a local government provider who accepts an assignment of benefits from a plan
governed by Maryland law, the provider may not balance bill the patient.
If you believe you’ve been wrongly billed, you may visit or contact the departments listed below:
• CAdENT Provider Bill, please contact your Provider’s billing office. Click here to view our
centers
• Maryland: Health Education and Advocacy Unit of Maryland’s Consumer Protection Division
• Virginia: The Virginia Bureau of insurance
• District of Columbia: Department of Insurance, Securities & Banking

Get a Cost of Care Estimate

You have the right to receive a good faith estimate ahead of scheduled nonemergency health care
services, if you are an uninsured or self-pay patient. A good faith estimate shows the cost of items and
services that are reasonably expected for your scheduled visit. The estimate is based on information
known at the time the estimate was created, and can include costs related to your visit such as medical
tests, medications, DME and facility fees.
Your provider’s office will give you the estimate in writing at least one day before your medical service
if your care has been scheduled at least three days in advance. You may also request an estimate at
any time.
If you would like to receive a good faith estimate, please call your provider’s billing department.
For details about the law, visit the No Surprises Act site from the Centers for Medicare and Medicaid
Services.