Insurance & Payment

Colorado Springs Ear Associates accepts Medicare, TRICARE and nearly all commercial 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 Health First Colorado/Medicaid provider.

Colorado Springs Ear Associates is a contracted network provider with nearly all commercial major medical insurance companies. Examples include United Healthcare, Anthem, Kaiser, Humana, Cigna and Aetna.

We are a network provider for Christian Care Ministries Medi-Share. However members of other cost sharing programs are required to pay in full for their visit at the time of service.

While we welcome patients with indemnity and limited benefit plans (e.g., Freedom Life Insurance) we will not submit a claim for your visit. We require patients with indemnity insurance plans to pay in full at the time of service.

We do not accept medical discount cards.

We do not accept medical discount cards.

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.

As a sub-specialty clinic we provide an in-depth examination of your condition. For example, we may require additional tests for a particular type of hearing loss or a procedure to address symptoms of vertigo. Since these issues cannot be determined until you are examined by our doctors, we cannot provide a cost estimate or billing codes prior to your visit.

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
• Centura Colorado Doctors Plan
• United Healthcare Colorado Health Neighborhoods Plans
• HMO Colorado Blue Priority
• Pueblo County AARP Secure Horizons Plans
• Fremont County AARP Secure Horizons Plans
• Aetna Medicare Advantage Plans
• Cigna Medicare Advantage Plans
• Anthem MediBlue Dual Advantage HMO SNP
• Colorado Medicaid/First Health Colorado

If you insurance claim is denied because our clinic is an out-of-network provider you will be responsible for the cost of your visit.

We collect copays for every clinical appointment in our office, including office visits, diagnostic testing and cochlear implant programming, regardless of whether your appointment includes a visit with Dr. Hegarty.

Most insurances require a copay for all types of appointments. If you paid a copay for a visit that did not require it we will refund your copay after your insurance claim has paid. We will also reimburse any copays collected after you have reached your out-of-pocket maximum. Please note: Medicare Advantage plans require copays for ALL visits.

Some insurances require copays even if they are not shown on your insurance card. We will collect Specialist copays for the following insurances:

• TRICARE Prime retirees: $30

• BCBS FEP Blue beneficiaries: $40

• AARP Medicare Supplement Plan N: $20

Please note that some Anthem BCBS and Medicare Supplement Plans may have copays that are not shown on your card. If your billing history indicates a copayment we will ask you to pay that copay amount when you check in for your appointment.

We will not collect copays if you have a secondary insurance other than Health First Colorado/Medicaid. If you have commercial insurance and Medicaid as a secondary you will have to pay the copay, if any, on your commercial insurance card.

We do not collect copays for post-operative visits in the global period.

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.

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 appointment at Colorado Springs Ear Associates.

We do not submit claims for indemnity insurance plans. You will be required to pay for your visit in full when you check in for your appointment; but you can submit your charges to you insurer for reimbursement.

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. Please refer to the “How much will my visit cost?” FAQ.

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. 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.

If your insurance card has multiple copay types we will always collect the highest office visit copay on your card. It will be the Specialist copay or the highest Tier or Level copay on your card. We collect copays when you check in for your appointment.

We have several payment methods available. If you would like to use a credit, debit or CareCredit card you can use our online bill payment portal. No login or account information is required to pay your bill online.

You can pay with Zelle if your bank provides this service. Zelle securely transfers money from your bank account to ours, simply send your payment to billing@springsear.com. Zelle is free but your bank may require that you use online banking or a mobile app to send the payment.

You may also mail a check to our office or call our office to pay with a credit card or CareCredit. 

If you have an HMO, Select, or Limited Network plan your insurer may require that you have an authorization from your primary care provider to see Dr. Hegarty. If you are unsure, please contact your insurer prior to your visit to determine if an authorization is required.

Please note that a referral from your physician may not suffice if your plan requires an authorization. A referral is a request that your doctor sends to Colorado Springs Ear Associates to ask that we see you as a patient. It does not mean that your referring physician or PCP has contacted your insurance company to obtain an authorization to see Dr. Hegarty.

If your plan requires an authorization, your PCP will have to contact your insurer and request an authorization number for your visit(s) to Colorado Springs Ear Associates prior to making your appointment. If you require an authorization but do not have one prior to your visit you will be responsible for the cost of your visit.

All TRICARE Prime beneficiaries require an authorization to see Dr. Hegarty.

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.

Colorado Springs Ear Associates is a participating provider and accepts assignment for TRICARE services.

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.

Yes, if you have Medicare Part B as your primary coverage and a Medicaid plan as secondary or tertiary coverage you are able to receive care at Colorado Springs Ear Associates.

Even though we are a non-participating provider we will require a copy of your current Health First Colorado card when you check-in for your appointment.

Yes, if you have commercial 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 commercial insurance, we will collect your primary insurance copay when you check in for your appointment unless your have a Medicare Advantage plan. 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. You will not be required to sign a waiver if you have a Medicare Advantage plan.

Even though we are a non-participating provider we will require a copy of your current Health First Colorado card when you check-in for your appointment.

No, unfortunately state law prevents non-participating providers such as Colorado Springs Ear Associates from offering services to patients with Medicaid as their primary insurance.

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.

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 be aware that you may be responsible for the cost of all or most of your surgery if you have a high deductible that has not been met. Please contact our office if you require assistance or information regarding your procedure.

If you do not medical insurance and would like to privately pay for a surgical procedure, please call our office for more information.