Accepted Insurance and Health Plans
Affiliates in Plastic Surgery, LLC is pleased to accept health plans from most major insurance providers. The following list should be considered guidelines only as many insurers offer a wide variety of plan options that may determine, at the individual plan option level, whether or not a patient will be in network with Affiliates in Plastic Surgery, LLC. Insured individuals should check with their employer’s benefits manager, broker, or plan manual to ensure they are accessing care through their plan option’s preferred providers to ensure they are receiving the highest benefit level.
Our office works with Georgetown Dermpath in Washington, DC. Insurers may require that patients use specific lab services – please check your card or plan manual to ensure you have lab benefits.
Foreign Service Benefit Plan
Medicare HMO and PPO
ANTHEM HEALTHKEEPERS PLUS
A Managed Care Organization
AMERIGROUP OF MARYLAND
A Managed Care Organization
BREAST AND CERVICAL CANCER TREATMENT PROGRAM (BCCTP)
DHMH – BCCP
CAREFIRST BLUE CROSS BLUE SHIELD
APWU Health Plan
SAMBA Health Benefit Plan
MOLINA COMPLETE CARE
MARYLAND PHYSICIANS CARE
A Managed Care Organization
MEDICARE PART B
Railroad Retirement Board
Coverage varies by insurer and insurer’s plan options. Check with your employer’s benefits manager, broker, or plan manual to ensure they are accessing care through their plan option’s preferred providers to ensure they are receiving the highest benefit level
A Managed Care Organization serving Maryland
Serving the Commonwealth of Virginia
Choice Advanced/Choice Advanced Plus
Compass Rose Health Plan
Core and Core Essential
M.D. IPA Plan
Medical Advantage Plans including Dual Complete
UNITED HEALTHCARE COMMUNITY PLAN OF VIRGINIA
A Managed Care Organization (We are in network with this plan for the state of Virginia only)
US FAMILY HEALTH PLAN
Johns Hopkins Medicine
Accident Fund Insurance Company
AS&G Claims Administration
Creative Risk Solution
Crum and Forster
Eastern Alliance Insurance Group
Gallagher Bassett Services
Helmsman Management Services
Mac Risk Management
Nationwide Mutual Insurance Company
Travelers Insurance Group
York Risk Services
Zurich Insurance Group
Glossary of Terms
Understanding your insurance and how it works can be difficult and confusing. We are here to help you understand your medical coverage, its terms and what benefits apply to you.
This is an amount established by an insurance company that it will pay. This varies per insurance company and per patient benefit contract.
A written consent to release protected health information. Some patients, such as HMO patients may be required to obtain permission or authorization to receive certain services.
Co-insurance refers to an amount that a patient or insured person is contractually required to pay for medical care, after a deductible has been applied. Co-insurance is often specified by a percentage.
Co-payment is a predetermined (flat) fee. This fee is based on a contract between an employer or patient and an insurance company. A co-payment that a patient pays for health care services is in addition as an out-of-pocket expense to what the insurance company covers for the service provided. A co-payment is separate from a deductible and co-insurance.
A deductible is a contractual amount that the patient is required to pay as an out-of-pocket expense before the insurance company pays any claim sent to them. The amount of deductible varies per patient and per insurance policy.
EOB (EXPLANATION OF BENEFITS)
A written statement to a beneficiary, from a third-party payer, after a claim has been reported, indicating the benefits and charges covered or not covered by the medical benefits plan.
EPO (EXCLUSIVE PROVIDER ORGANIZATION)
Insurance plan allows access to health care from a network physician, facility or other health care professional, including specialists, without designating a Primary Physician or obtaining a referral- there is no claim forms or bills. Benefits are available for office visits and hospital care, as well as inpatient and outpatient surgery. Does not provide out of network.
HMO (HEALTH MAINTENANCE ORGANIZATION)
An HMO is a legal entity that consists of participating medical providers that provide or arrange for care to be furnished to a given population group for a fixed fee per person. HMOs are used as alternatives to traditional indemnity plans as a way to manage costs and keep health care expenses low.
In-network refers to providers or health care facilities that are part of a health plan’s network of providers with which it has negotiated a discount. Insured individuals usually pay less when using an in-network provider, because those networks provide services at lower cost to the insurance companies with which they have contracts.
Also known as an out of network provider or a non-contracted provider.
OUT OF NETWORK
This phrase usually refers to physicians, hospitals or other health care providers who are considered nonparticipants in an insurance plan (usually an HMO or PPO). Depending on an individual’s health insurance plan, expenses incurred by services provided by out-of-plan health professionals may not be covered, or covered only in part by an individual’s insurance company.
OUT OF POCKET
The portion of the medical care costs for covered services that are required to be paid by the patient, including co-payments, co-insurance, and deductible.
OUT OF POCKET MAX
Limits the amount of out-of-pocket expenses a patient will have to pay. The cap applies to all covered services. Once the patient meets the their out of pocket max, there are no moreout-of-pocket expenses.
POS (POINT OF SERVICE)
POS plans are similar to PPO plans; however, they require covered persons to select an in-network personal care physician. Under a POS plan, participants can seek care outside of the network and still have coverage. In-network care is covered at higher benefit levels than out-of-network care.
PPO (PREFERRED PROVIDER ORGANIZATION)
A program that establishes contracts with providers. Providers that are contracted with an insurance company are called preferred providers by the insurance company. They are also called “Par” or “In Network” providers.Patients who belong to a PPO health insurance plan can usually seek care outside the network without having to obtain authorization or pre-approval.
This is healthcare coverage that is mandated by State law to be provided to an employee in the event of work related injuries and illnesses. Each State has its own laws and regulation on managing workers compensation. Some employers may be exempt from providing workers compensation insurance.
WANT TO PAY YOUR BILL ONLINE?
Contact our billing department to get enrolled in our patient portal on Kareo.com!
Please allow 24-48 hours for activation.