Thank you so much for choosing James askew MD, FACS for your ENT care

In an effort to help you make your medical journey easier, we have included some tips on working with insurance.

The insurance is that we accept are constantly changing. Currently we accept Blue Cross Blue shield HMO policies require referral, Aetna, Cigna, traditional Medicare, Oscar some Oscar insurance is due require referral, Tricare some policies require referral, Medicare advantage plans that we take are Medicare Aetna Medicare Blue Cross Blue shield those are in network. We also take phcs. If you have Humana or United we can see you however you're out of network benefits will be utilized. We are in negotiations with insurances and will update our list as soon as we are allowed in the networks. Some insurance is that we are waiting to get in their Network are humana, united healthcare, Molina, sendero, and ambetter.

Do you have medicare or do you have a replacement?

Medicare is typically a red, white, and blue card with the patient's name and the member number which has a series of letters and numbers. Some people only have traditional Medicare and some have traditional Medicare with secondary coverage. Common secondaries are AARP, Blue Cross, and Mutual of Omaha. Some people have an Advantage plan this is Medicare Advantage. This plan takes the place of Medicare. Patients may have a traditional Medicare card, however that card is invalid since they are replacing their Medicare with an Advantage plan. Some examples of Medicare advantage are Aetna Medicare Advantage Blue Cross Blue Shield, Medicare Advantage Cigna, Medicare Advantage Humana, Medicare Advantage or United Medicare Advantage. If you have questions about your coverage please let us know and we will do our best to assist you.

Do you have an HMO or a PPO?

If you have an HMO please be advised you will need an authorization number and referral. Your insurance is requiring that you have permission from your primary care doctor to see a specialist.

What is a copay?

A copay is an amount that your insurance has deemed you need to pay at time of your office visit. Sometimes a copay can vary between offices, such as primary care, specialist, or urgent Care.

What is a deductible?

A deductible is an amount that your insurance has said you need to meet out of pocket before the insurance will " kick in some insurances have patient deductibles or family deductibles in most cases your deductible will need to be met before your insurance will pay out a claim.

Something that insurance also has is a coinsurance a coinsurance amount can be anywhere between 10% to 40% patient responsibility. The coinsurance kicks in after you have met your deductible. Your out of pocket is the total amount that you must pay out of your pocket. This includes deductible, coinsurance, and copays.

In regards to surgery some procedures and some insurances require a prior authorization. Insurance can take up to two weeks to release a prior authorization to our office. Once the physician has told us what procedure you were needing we then contact the insurance to see if that procedure requires an authorization those authorizations are given a particular number as well as a date range. Your insurance also determines where your procedure can be performed. Something to keep in mind when dealing with insurance and providers is always make sure that your insurance is in network. If you call and say does an office take your insurance the answer is yes most offices do take any insurance but then may charge out of network benefits. It is typical practice once your procedure has been scheduled to be given a quote of cost. This is an estimate your insurance has given us and typically we do ask for a down payment or payment in full depending on what you have worked out with the office manager. After surgery you have something called a global. These office visits are included in your procedure cost. The physician will need to monitor you post op to make sure you are healing correctly as well as in the aftercare that needs to be done.