Insurance and Payment
What types of insurance do you accept?
Colorado Springs Ear Associates accepts Medicare, TRICARE and nearly all private insurances. However, every insurance plan is different so you should contact your insurance company prior to your appointment to confirm that we are a network provider. Colorado Springs Ear Associates is not a Medicaid provider.
How much will my visit cost?
Every patient is unique and so is every patient’s visit. We do not know in advance which diagnostic tests, procedures and treatments you will require during your visit. As a result we are unable to provide an estimate of the cost determined by your insurer or provide the CPT codes that will be submitted on your insurance claim.
Are you Out of Network for any insurances?
Colorado Springs Ear Associates is contracted with all of the major commercial insurance companies. However, many insurance companies now offer limited network plans and even though we are a network provider for virtually all of an insurer’s members, as a sub-specialty clinic we are occasionally excluded from limited network plans. We encourage all patients to contact their insurer to confirm that we are a network provider for their plan. If you do have a limited network plan and Dr. Hegarty is out-of-network, contact your insurer and/or PCP to request an authorization to see him. Since Colorado Springs Ear Associates is the only practice offering certain services in southern Colorado many insurers will authorize and cover the costs of out-of-network visits. However, you must obtain the authorization before your first visit. As of 2018, Colorado Springs Ear Associates is out-of network for the following plans:
- Bright Health Plans
- Centura Value Plan
- HMO Colorado Blue Priority (Anthem BCBS)
- Pueblo County AARP Secure Horizons Plans
- Fremont County AARP Secure Horizons Plans
- Anthem MediBlue Dual Advantage HMO SNP
- Colorado Health Neighborhoods Plans
Will my insurance pay for hearing aids?
Many insurance plans provide coverage for hearing aids, and state law requires insurance coverage for children under 18. Medicare Part B does not pay for hearing aids but some Medicare supplement and replacement plans do provide hearing aid coverage. At Colorado Springs Ear Associates, we will determine if you have a hearing aid benefit and submit your claim.
I have a limited benefit/medical indemnity insurance plan. Will my office visit benefit cover the cost of my visit to Colorado Springs Ear Associates?
If you have a limited benefit medical insurance plan we encourage you to confirm exactly what is covered by your plan before your visit. Many limited benefit plans include a fixed benefit for a physician office visit, such as $75 or $100. However, this benefit may only apply to the office visit. Your plan may not cover the diagnostic tests or procedures that are routinely performed during an office visit at Colorado Springs Ear Associates. If that is the case you will be billed for any portion of the visit that is not covered by your benefit.
How much will it cost to see Dr. Hegarty if I have medical insurance?
If you plan to use insurance for your visit with Dr. Hegarty, we will not know how much it will cost you until after your insurance claim is processed. Your insurance company determines the amount Dr. Hegarty is paid for his services and how much of that balance, if any, you are required to pay. However, the amount that Dr. Hegarty bills your insurance will depend on your individual needs and cannot be precisely determined prior to your visit.
Your insurance company can provide you with information on your deductible, co-insurance and co-pays to help you determine the extent of your patient responsibility.
If you would like to privately pay for an office visit or procedure, please call our office for more information.
How much will it cost to see Dr. Hegarty if I self pay?
If you would like to privately pay for an office visit or procedure, please call our office for more information. Private pay patients must pay in full for their visit when they check-in. However, our self pay fees are pre-determined and will not vary for a single visit.
What type of copay do you collect?
If your insurance card has multiple copay types we will always collect the Specialist or Level 2 copay. We collect copays when you check in for your appointment.
Certain Anthem BCBS plans, such as FEPBlue, have copays that are not indicated on the card. We will ask you to pay your copay before your visit if you have one of these plans.
I have TRICARE, do I need a referral for a visit?
If you have TRICARE Prime, you must have an authorization from TRICARE to see Dr. Hegarty. Our office will call you to schedule your visit once we receive your authorization number. An existing referral for another physician is not transferable to Dr. Hegarty.
If you have TRICARE Select or TRICARE for Life, you do not need a referral or authorization to see Dr. Hegarty.
If you have TRICARE Prime and are non-active duty you can use the Point of Service option to see Dr. Hegarty without a referral. Dr. Hegarty accepts assignment for TRICARE services.
I would like to self-pay for my visit, what payment options do you offer?
We accept all major credit cards, personal checks with photo ID, cash and CareCredit. Please note that payment in full will be collected when you check in for your appointment.
I have Medicare but I also have a Health First Colorado/Medicaid plan as secondary coverage. Can I still see Dr. Hegarty even though he is a non-participating provider?
Yes, if you have Medicare as your primary coverage and a Medicaid plan as secondary or tertiary coverage you are able to receive care at Colorado Springs Ear Associates.
I have private insurance but I also have a Health First Colorado/Medicaid plan as secondary coverage. Can I still see Dr. Hegarty even though he is a non-participating provider?
Yes, if you have private insurance or Medicare as your primary coverage and a Medicaid plan as secondary or tertiary coverage you are able to receive care at Colorado Springs Ear Associates.
If your Medicaid plan is secondary to private insurance, we will collect your primary insurance copay when you check in for your appointment. You will also be billed for any deductible balance that is not covered by your primary insurance. The state of Colorado requires that you sign a waiver that states that you know that Colorado Springs Ear Associates is not a Health First Colorado/Medicaid provider and that you will be billed for copays and/or deductibles that are not covered by your primary insurance.
I have a limited benefit/short term medical insurance plan. Are you an in-network provider?
We will be in-network if your limited benefit medical plan utilizes a physician network in which we participate. Please check the online provider network directory for your plan to confirm our network status.
How much will my surgery cost?
Your insurance company can provide you with an approximate quote for the amount of a surgical procedure you will be responsible for paying. We encourage you to contact your insurer so you are aware of the fees that will be applied to your deductible and coinsurance. Please contact our office if you require assistance.
If you would like to privately pay for a surgical procedure, please call our office for more information.