INSURANCE PLANS

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. 

AETNA

Aetna International

Choice POS

HMO

EPO

Foreign Service Benefit Plan

Innovation Health

POS

PPO

Medicare HMO and PPO

MHBP

Select/Open Access

Signature Partners

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

BlueChoice Advantage
Carefirst Administrators/NCAS
HMO
FEP
PPO

CIGNA

APWU Health Plan
Connect
Cigna HealthSpring
HMO
Medicare Advantage
Open Access/Plus
PPO
SAMBA Health Benefit Plan

MOLINA COMPLETE CARE

CCC Plus

Medallion

MARYLAND PHYSICIANS CARE

A Managed Care Organization

MEDICARE PART B

Palmetto GBA
Novitas Solutions
Railroad Retirement Board

MULTIPLAN/PCHS

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

PRIORITY PARTNERS

A Managed Care Organization serving Maryland

SIGNATURE PARTNERS

Serving the Commonwealth of Virginia

UNITED HEALTHCARE

AARP

All Savers

Choice/Choice Plus

Choice Advanced/Choice Advanced Plus

Compass Rose Health Plan

Core and Core Essential

GEHA

Golden Rule

HMO

M.D. IPA Plan

Medical Advantage Plans including Dual Complete

Optimum Choice
OneNet PPO

PPO/Options PPO

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

WORKERS COMPENSATION

Accident Fund Insurance Company
Amerisafe
Amerisure
AS&G Claims Administration
Broadspire
Chubb Group
CNA
CorVel
Creative Risk Solution
Crum and Forster
Donegal Insurance
Eastern Alliance Insurance Group
ESIS
Gallagher Bassett Services
Helmsman Management Services
Liberty Mutual
Mac Risk Management
Nationwide Mutual Insurance Company
PMA
Risk Management
Sedgwick
Selective Insurance
SISCO
The Hartford
Travelers Insurance Group
York Risk Services
Zurich Insurance Group

HELP CENTER

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.

ALLOWED AMOUNT

  • This is an amount established by an insurance company that it will pay. This varies per insurance company and per patient benefit contract.

AUTHORIZATION

  • 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

  • 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

  • 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.

DEDUCTIBLE

  • 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

  • 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.

NON-PARTICIPATING PROVIDER

  • 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.

WORKERS COMPENSATION

  • 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.

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