We Work With Your Insurance
Capital ENT accepts most major insurance plans — including Medicare. Our billing team verifies your benefits before your appointment so there are no surprises.
Insurance Plans We Accept
We participate with most major commercial and Medicare plans. Don't see yours listed? Call us — we accept many additional plans not listed here.
Commercial PPO & HMO
- Aetna
- BlueCross BlueShield of Texas
- Cigna
- United Healthcare
- Humana
- Scott & White Health Plan
- Baylor Scott & White
- Community Care (CCPN)
HMO members may need a referral from their PCP before scheduling.
Medicare & Medicare Advantage
- Original Medicare (Parts A & B)
- Aetna Medicare Advantage
- BCBS Medicare Advantage
- Humana Medicare Advantage
- UHC Medicare Advantage
- WellMed
- Cigna Medicare Advantage
Medicare covers medically necessary ENT services. A small co-pay or 20% co-insurance typically applies after your deductible.
PPO plans can schedule directly — no referral needed. HMO plans require a referral from your PCP first. Not sure? Check the back of your insurance card or call 512-339-4040.
What Does Insurance Typically Cover?
Most major plans cover these ENT services when medically necessary. Coverage varies by plan.
| Service | Most Commercial Plans | Medicare | Notes |
|---|---|---|---|
| Office Visit / ENT Consultation | ✓ Covered | ✓ Covered | Co-pay or co-insurance applies after deductible |
| Hearing Evaluation (Audiogram) | ✓ Covered | ✓ Covered | When ordered by a physician for medical reasons |
| Balloon Sinuplasty (BSP) | ✓ Covered | ✓ Covered | Prior authorization required; must document failed medical therapy |
| Endoscopic Sinus Surgery (FESS) | ✓ Covered | ✓ Covered | Prior authorization required; CT imaging and documentation needed |
| Septoplasty (deviated septum) | ✓ Covered | ✓ Covered | Covered when functionally necessary; cosmetic component not covered |
| Tonsillectomy / Adenoidectomy | ✓ Covered | ✓ Covered | Prior authorization may be required; criteria vary by plan |
| Ear Tube Placement (Tympanostomy) | ✓ Covered | ✓ Covered | Typically covered after documented recurrent infections |
| Allergy Testing (Skin Prick Test) | ✓ Covered | ✓ Covered | When medically indicated; co-pay applies |
| Allergy Shots (SCIT) | ✓ Covered | ✓ Covered | Covered by most plans after testing; prior authorization may apply |
| Allergy Drops (SLIT) | Not Covered | Not Covered | Off-label in the US; affordable self-pay option available |
| Sleep Study Referral | ✓ Covered | ✓ Covered | ENT evaluation covered; sleep study billed separately by sleep lab |
| Hearing Aids | Varies | Not Covered | Some plans offer a hearing aid allowance; Medicare Advantage may cover |
This table is a general guide only. Actual coverage depends on your specific plan, deductible status, and medical documentation. Our team will verify your individual benefits.
Prepare for Your Appointment
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Call us to verify coverage Call 512-339-4040 with your insurance card info. We verify in-network status, deductible, and estimated co-pay before you arrive.
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Bring insurance card(s) & photo ID All current cards (front and back) plus a valid government-issued photo ID. Let us know if your insurance has changed.
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Get a referral (HMO only) HMO plans require a referral from your PCP. Bring the referral form or authorization number to your visit.
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Medication list & prior records Current medications (including supplements) and any prior CT scans, MRIs, or hearing tests related to your visit.
No Insurance? No Problem.
We welcome uninsured and self-pay patients. Our billing team provides a good-faith estimate before your appointment, and we offer flexible payment plans to make care accessible.
- Transparent pricing — know your costs upfront
- Flexible payment plans for procedures
- No referral required
- Same high-quality care as insured patients
Billing & Insurance FAQ
Ready to Schedule?
Our billing team verifies your coverage before you come in — so you know exactly what to expect. Call us or request an appointment online.