Billing & Insurance
We accept most PPO’s, Medicare, Meritage Medical Group HMO and Canopy Health HMO. You will be responsible for ALL co-pays, deductibles and non-covered services. We accept Visa, Mastercard, personal checks and cash.
Health insurance can seem quite confusing – and different plan options have different rules and regulations depending on which state you live. It is ultimately up to you, the patient, to understand the details of your plan’s terms, benefits and coverage options in order to avoid any unexpected costs and hassles.
We are listed as participating providers for the following insurances:
• Aetna PPO
• Anthem Blue Cross PPO*
• Blue Shield PPO
• Cigna PPO
• HealthNet PPO**
• Medicare & most supplements (e.g.: AARP)
• Meritage Medical Group
• United Health Care PPO
* Only Dr. Agbayani is currently contracted with Blue Cross Pathway & Covered California
** Dr. Agbayani is currently not contracted with HealthNet IFP EPO
There is something new in the Bay Area and its called Canopy Health. Owned by physicians and hospitals, Canopy Health is a community of caregivers championing health. Their focus is on improving health, advocating for the entire Bay Area, and supporting individuals in a way that is empathetic and respectful. Their large network of physicians and other providers offers consistently high-quality care with clear, foreseeable costs.
Canopy Health is owned by UCSF Health, John Muir Health, Muir Medical Group IPA, Hill Physicians Medical Group, and Meritage Medical Network.
If your insurance carrier is not listed here please contact the Billing department to confirm if we are contracted.
We are currently not contracted with Medi-Cal and Partnership Healthplan.
Paying your account balances
You can send your checks/ credit card information with your statement directly to our office at 1000 South Eliseo Drive Suite 103, Greenbrae, CA 94904. Another option would be to provide your credit card information to our billing staff by calling our billing department at (415)461-9770 ext. 4.
Although, we currently do not support payments through our website. We are in the process of looking into online bill payments.
Online bill payments through your Bank:
Another option would be to set up online bill payments from your bank to take care of your Marin ENT balances. This way you can avoid having to write checks and put postage on an envelope.
Here are some links to help you:
We understand that a few of our patients experience financial difficulties. If this is the case, please let us know so that we can assist you in setting up a payment plan. If you keep your account active, you can avoid having your account go into collections. If you would like to discuss your account, please do not hesitate to contact us at (415)461-9770 ext. 4.
Glossary of common insurance terms:
Coinsurance – A form of medical cost sharing in a health insurance plan that requires an insured person to pay a stated percentage of medical expenses after the deductible amount, if any, was paid.
¨ Once any deductible amount and coinsurance are paid, the insurer is responsible for the rest of the reimbursement for covered benefits up to allowed charges: the individual could also be responsible for any charges in excess of what the insurer determines to be “usual, customary and reasonable”.
¨ Coinsurance rates may differ if services are received from an approved provider (i.e., a provider with whom the insurer has a contract or an agreement specifying payment levels and other contract requirements) or if received by providers not on the approved list.
¨ In addition to overall coinsurance rates, rates may also differ for different types of services.
Copayment – A form of medical cost sharing in a health insurance plan that requires an insured person to pay a fixed dollar amount when a medical service is received. The insurer is responsible for the rest of the reimbursement.
¨ There may be separate copayments for different services.
¨ Some plans require that a deductible first be met for some specific services before a copayment applies.
Deductible – A fixed dollar amount during the benefit period – usually a year – that an insured person pays before the insurer starts to make payments for covered medical services. Plans may have both per individual and family deductibles.
¨ Some plans may have separate deductibles for specific services. For example, a plan may have a hospitalization deductible per admission.
¨ Deductibles may differ if services are received from an approved provider or if received from providers not on the approved list.
Maximum out-of-pocket expense – The maximum dollar amount a group member is required to pay out of pocket during a year. Until this maximum is met, the plan and group member shares in the cost of covered expenses. After the maximum is reached, the insurance carrier pays all covered expenses, often up to a lifetime maximum.
Preferred provider organization (PPO) plan – An indemnity plan where coverage is provided to participants through a network of selected health care providers (such as hospitals and physicians). The enrollees may go outside the network, but would incur larger costs in the form of higher deductibles, higher coinsurance rates, or non-discounted
charges from the providers.
Exclusive provider organization (EPO) plan – A more restrictive type of preferred provider organization plan under which employees must use providers from the specified network of physicians and hospitals to receive coverage; there is no coverage for care received from a non-network provider except in an emergency situation.
Health maintenance organization (HMO) – A health care system that assumes both the financial risks associated with providing comprehensive medical services (insurance and service risk) and the responsibility for health care delivery in a particular geographic area to HMO members, usually in return for a fixed, prepaid fee. Financial risk may be shared with the providers participating in the HMO.
Individual Practice Association (IPA) HMO– A type of health care provider organization composed of a group of independent practicing physicians who maintain their own offices and band together for the purpose of contracting their services to HMOs. An IPA may contract with and provide services to both HMO and non-HMO plan participants.
Point-of-service (POS) plan – A POS plan is an “HMO/PPO” hybrid; sometimes referred to as an “open-ended” HMO when offered by an HMO. POS plans resemble HMOs for in-network services. Services received outside of the network are usually reimbursed in a manner similar to conventional indemnity plans (e.g., provider reimbursement based on a fee schedule or usual, customary and reasonable charges).
Here is another site you can check out for other common insurance terms at Healthcare.gov