Below we have listed various forms and policies supplied by MAUA that are necessary before patients can begin treatment. Please view and read each document carefully. Should you have any questions, please feel free to contact us. Please be sure to reference the form that you are having difficulty with, so that we may assist you properly. This information may be updated at any time, and we ask that you check back periodically to ensure that you have the most up-to-date information from MAUA. Below you will find all the necessary forms that we ask you complete prior to your visit to the office (to save time). We require that all new patients must complete the Patient Registration Form and return to MAUA prior to beginning treatment. It is important to note that this information must be filled out completely and accurately in order for us to better serve you.
- Patient Registration Forms (PDF) (to download adobe acrobat reader click here)
Overview
What your options are in reference to NON-PARTICIPATING physicians if you have:
- A traditional HMO
- HMO opt-out plans without out-of-network benefits
- HMO opt-out plans with out-of-network benefits
- Non-HMO indemnity plans
Traditional HMO
The Traditional HMO includes the following:
- Aetna
- CareFirst BlueChoice
- CareFirst POS Plan
- Kaiser
- United Healthcare
It is important to note the following:
- Members with traditional HMO benefits can see a participating physician or facility only when referred by their PCP (need a referral).
- Members may not see a non-participating physician even with a referral. If a member wants to see a non-participating physician, the member needs to sign a strictly cash arrangement waiver. The physician’s office must collect all fees at the time of service. No claims may be filed with the carrier by either party. HMO carriers will not reimburse services rendered by a non-participating physician in an out-patient setting.
- According to Maryland state law, if members are treated in a trauma or in-patient situation, the carrier must pay the non-participating physician fee. Under these circumstances, physicians must be aware that they may need to file an appeal(s) and therefore payments can be delayed.
HMO Opt-Out plans without out-of-network benefits
The HMO Opt-Out plan without out-of-network benefits includes:- Kaiser
- Members without out-of-network benefits can see a participating physician in an out-patient setting without a referral, but must sign our waiver stating they are aware they are using PPO benefits.
- Members may not see a non-participating physician even with a referral. If a member wants to see a non-participating physician, the member needs to sign a strictly cash arrangement waiver. The physician’s office must collect all fees at the time of service. No claims may be filed with the carrier by either party. HMO carriers will not reimburse services by a non-participating physician in an out-patient setting.
- According to Maryland state law, if members are treated in a trauma or in-patient situation, the carrier must pay the non-participating physician fee. Under these circumstances, physicians must be aware that they may need to file an appeal(s) and therefore payments can be delayed.
HMO Opt-Out plans with out-of-network benefits
The HMO opt-out plan with out-of-network benefits includes:- Aetna Open Access
- CareFirst / BlueChoice Open Access
- CareFirst POS
- United Healthcare
- Members with out-of-network benefits can see a non-participating physician in an out-patient setting without referral.
- Members need to sign an out-of-network waiver, agreeing to pay balances unpaid by the carrier.
- Members may assign benefits to the physician. Depending on the carrier, assignment of benefits may not be recognized. Under these circumstances, the carrier may send the payment to the member, rather than the physician directly. In which case the patient must endorse the check to the physician and send it in.
- According to Maryland state law, if members are treated in a trauma or in-patient situation, the carrier must pay the non-participating physician fee.
Non-HMO indemnity plans
The Non-HMO indemnity plan includes:
- Out-of-Network
- BCBSNCA Federal CareFirst MD
- Cigna
- Non-Par Waiver
- Members with indemnity plans can see any physician in an out-patient setting or in-patient setting.
- Members may assign benefits to the physician. Depending on the carrier, assignment of benefits may not be recognized. Under these circumstances, the carrier may send the payment to the member, rather than the physician directly. In such a case, the patient must endorse the check to the physician and send it in.
Ready to schedule a consultation?
Call (301) 477-2000 or fill out an Online Appointment Request Form to setup your initial consultation.
At MAUA we are experts on the subject of male urinary incontinence diagnosis and treatment. Please contact us if you have any questions or want to know more about our various treatment options and schedule a consultation.
