Insurance & Fees

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
• CareFirst BCBS
• Cigna Healthcare
• HealthNet Federal Services (HNFS) Tricare
• Humana
• Medicare – Novitas – DC/Surr. Counties
• Multiplan/PHCS
• Railroad Medicare DC
• United Healthcare
• WebTPA – Custom Ink

*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.

Referrals
It is your responsibility to know if your insurance requires a referral to see a specialist and to obtain that referral from your Primary Care Physician. We must have your referral at the time of your visit.

Verification of Benefits
We will verify your benefits prior to your initial consultation and again, if surgery is scheduled. We will determine if you have a deductible and how much of that deductible was met, a co-insurance and/or a co-pay. Our policy is to collect any deductibles, co-insurances or co-pays at the time of your office visit or prior to your surgical procedure.

Surgery
Once surgery is scheduled you will be contacted by our billing office, explaining how your benefits work and what your estimated financial obligation will be. We are here to answer any questions you may have regarding your insurance benefits.

Financial Policy

Deductibles/Co-Insurances for Surgery:

Advanced Surgery requires you to pay any in-network or out of network deductibles and/or co-insurance portions prior to your scheduled surgery. Our billing department will contact you with an estimated amount. This is only an estimate; after we receive payment from your insurance carrier we will either bill or refund you according to your insurance explanation of benefits. We accept Visa, MasterCard, Discover or personal checks. If paying by check, we must receive payment no later than 3 days prior to your scheduled surgery.

Please note: The fees collected and billed to your insurance carrier are for your surgical procedures performed by Dr. Sandler or Dr. Colliver. This does not include any fees you may owe to the Hospital, Ambulatory Surgical Center, Anesthesia, Pathology, Radiology or Laboratory Services, which are billed separately from our surgeon’s fees. We do not bill or collect deductibles and/or co-insurances for any of the above mentioned facilities. If you have any questions, please contact those facilities directly regarding any insurance questions you may have.

Pre-Authorization for Surgery:

Our office will contact your insurance company to obtain preauthorization for your procedure. However, this is not a guarantee that your insurance company will pay for your surgery. Patients are responsible for their benefits, coverage and payment for all services rendered by Advanced Surgery. We encourage our patients to take this opportunity to understand their personal insurance benefits. If you have any questions, you should contact your insurance carrier, employer HR Department or insurance broker to verify your benefits, eligibility and coverage.

Deductibles/Co-Insurances for Office Visits:

Advanced Surgery requires you to pay any in-network or out of network deductibles, co-pays and/or co-insurance portions at the time of your office visit.

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