In medicine, Otorhinolaryngology (Ear Nose & Throat) is considered a specialty (not primary care). Your insurance plan determines whether you are responsible for paying all or part of your visit. Also, many of our patients undergo diagnostic procedures during their visits. Commonly performed diagnostic and therapeutic procedures include rigid nasal endoscopies, flexible laryngoscopies, CT scan of the sinuses, rigid nasal debridement, and ear wax removal. It is important for you to know if your plan has a copay, deductible, co-insurance, surgical deductible, or has different prices for specialty visits.
Questions you may want to ask your insurance company before your visit to GNO Snoring & Sinus:
- Do I require a referral or prior authorization to see a specialist physician?
- Do I have an office visit copay and/or deductible and coinsurance?
Below are the most common insurance codes for visits to GNO Snoring & Sinus:
- New Patient Visits: 99202, 99203, 99204
- Established Patient Visits: 99212, 99213, or 99214
- Rigid Nasal Endoscopy: 31231
- Flexible Laryngoscopy: 31575
- CT Scan Sinuses: 70486
- Nasal Debridement: 31237
- Ear Wax Removal: 69210
Below are the most common insurance codes for visits based on symptoms:
- Sinusitis/Nasal Congestion: 99203 or 99204, 31231
- Snoring/Sleep Apnea: 99203 or 99204, 31575
- CT Scan of Sinuses: 99213 or 99214, 70486
If you have a deductible within your insurance plan, you are responsible for any charges until your deductible is met. Here is a little cheat sheet on the most common types of insurance plans.
- Strictly Copay Plans: You pay a fixed amount per visit.
- Strictly Deductible Plans: You pay the allowed amount contracted by your insurance plan for the services rendered by a medical office until you reach your deductible. After you have reached your deductible, you may be subject to a coinsurance percentage until your out-of-pocket maximum has been met for the calendar year.
- Office Copay & Surgical Deductible Plans: A combination of the above two types of plans.
We strongly encourage our patients to understand the details of their plan.
We accept the following insurance plans. If you do not see your plan on this list, please call our office to determine if we accept it.
- Bayou Health Plans
- Coventry of LA
- LA Medicaid
- United Healthcare
- Vantage Health Plan
- Wellcare of LA
- Workers’ Compensation
Medical insurance is confusing! There are many different plans with many different coverage benefits. Therefore, we encourage all patients to understand the benefits of their insurance plans. Our office is always happy to help in any way possible.
Frequently Asked Questions
If Surgery is recommended after my office visit, will I be made aware of the cost?
Yes! In all circumstances, patients are made aware of their estimated benefits/coverage prior to undergoing surgery. This is done as a courtesy by our office to provide patients with an estimate of their costs.
I am scheduled to undergo a CT Scan of the Sinus. How much will this cost me?
The CPT code for CT Scan of the Sinus is 70486. Patients are encouraged to contact their insurance company to understand the coverage of this code with regards to their plan benefits. As a courtesy to our patients, our office obtains applicable prior authorization from the insurance company for this CPT code before billing it.
I have Private Insurance and received my Explanation of Benefits after my office visit. It states I had a "Surgery" and the insurance is not covering this. I did not have a "Surgery"
The categorization of a diagnostic CPT code as “Surgery” is not something our office performs. That is done by the insurance company. The categorization of diagnostic services as surgery by the insurance company often results in a higher cost-share to the patient in the form of a deductible and/or coinsurance, rather than simply a copay. We encourage patients to understand the coverage details of their plan and feel free to communicate the possible insurance codes that we may use to your insurance company for specifics. The codes can be found above under “codes used for visits based on symptoms”.
The examples above reflect commonly used CPT scenarios and do not reflect the entirety of CPT billing by a medical office. Insurance company benefits change constantly, therefore, the scenarios above are purely educational in nature and do not reflect definitive definitions of insurance coverage. Patients are responsible for understanding the details of their insurance plan and what is covered. Nothing in the above constitutes medical advice.