We want you to understand the terms used in the financial aspect of your upcoming procedure(s). Once we have verified your coverage and benefits, we will be able to discuss your financial responsibility. The information we provide you at that time will be our best estimate of your portion of the bill. This may change, depending on the procedures performed by your physician. Please feel free to contact us if you have any questions.
Co-pay: A specific charge that your insurance plan may ask you to pay for a specific medical service or supply. For example, your health insurance plan may require a $15 co-pay for an x-ray or brand-name prescription drug, after which the insurance company often pays the remainder of the charges.
Deductible: An amount established by your insurance company and your benefit plan that must be met on a yearly basis. Once you have paid your deductible, your insurance plan will begin to make payments for claims. Call your insurance company for the most up-to-date information regarding your deductible.
Co-insurance: The amount that your insurance company requires you to pay for covered medical services after you’ve paid any co-pay or deductible. Co-insurance is typically shown as a percentage of the charge. For example, if your insurance company covers 80% of the allowable charge for a specific service, you may be required to cover the remaining 20% as co-insurance.
Patient Financial Responsibility: The amount of money that is your responsibility, which is the total of any applicable deductible, co-pay and/or co-insurance.
We will file claims on all accounts in which there is complete and accurate insurance information (insurance name, address, policy number, group number, etc.). Bills are generally submitted to the primary insurance company within three days from your visit. If you have a secondary insurance company, a claim will be submitted to the secondary insurance after the primary insurance has paid.
You will receive a minimum of two bills: one from your physician for his/her services and one from Ambulatory Surgery Center for use of the facility. If a pathologist, laboratory or anesthesiology group is involved in your care, they will bill you separately.
Colonoscopies are performed for several reasons. They are coded based on the purpose of the colonoscopy and the results of the procedure.
- Screening – A screening colonoscopy is scheduled for patients that have no current, clinically significant GI signs or symptoms. Any previous screening colonoscopy must have been over 10 years ago for your insurance to pay for another. To be billed as a screening, your physician must see and do nothing out of the ordinary when the procedure is completed. If your insurance plan offers screening benefits, this will be covered at 100% and you will have no financial responsibility.
- Surveillance – A surveillance colonoscopy is performed to monitor a condition that was identified previously. The physician may request a surveillance colonoscopy to confirm that the condition hasn’t returned or worsened. Your insurance plan may classify this procedure as either screening or diagnostic. If classified as a screening, it may turn therapeutic based on the physician’s findings during the procedure. This may impact your financial obligation.
- Diagnostic – A diagnostic colonoscopy is performed as a result of your signs and symptoms (i.e., abdominal pain, blood in stool, chronic diarrhea, a change in bowel habits, weight loss, or blood-loss anemia). Only your physician can decide the significance of your signs and symptoms, and we must follow his/her orders.
- Therapeutic – A therapeutic colonoscopy is a result of some type of additional procedure performed during the course of one of the colonoscopies listed above. The physician may discover polyps, which are removed during the colonoscopy. There may be other issues that require additional procedures to resolve.
What happens if you come in for a screening colonoscopy and the physician finds and removes a polyp?
- We are required to submit the claim with the procedure code used to remove the polyp. Billing this colonoscopy as a “screening only” would constitute a false claim, which would result in serious consequences to our facility. We can use the screening as a secondary diagnosis, but not as the primary code.
- Your individual insurance plan will determine how your benefits will be applied towards this procedure. Once the claim is correctly coded and submitted to your insurance company, any payment is determined by them.
- If you have any questions please feel free to contact us at the phone numbers listed below.
- Digestive Health Associates billing/anesthesia 775-829-7600.
- Digestive Heath Center’s central billing office 855-451-6884.
- Miraca Pathology 888-451-6884
The examples listed above are generic examples and are NOT based on your individual insurance plan. Please call your insurance company to verify your benefits.