Billing information

Insurance

We participate as specialty providers with the following plans and networks: Medicare, Medicaid, all Anthem products, Aetna, Cigna, Coventry/First Health, Optima, Humana, United Healthcare/Mamsi products, OneNet PPO, Virginia Medicaid, and Medicaid HMOs, Multiplan (PHCS), Beechstreet, Virginia Health Network, as well as most Medicare advantage plans.

On your visit to our office, please bring your insurance identification card with you. If you are a member of an HMO plan requiring referrals, you are responsible for obtaining the required referral for any visits and procedures. If you present for your visit without a needed referral, you will be asked to sign a waiver and be responsible for any charges incurred.

You will be required to pay any co-pays at the time of your service. Payment may be made by cash (no large bills), check, MasterCard, Visa, Discover, American Express, or PayPal. You will be responsible for any remaining balances, including deductibles, co-insurance amounts, and non-covered services. You are responsible for your bill with this office, not your insurance company.

If you do not have insurance, you will pay a deposit at the time of the initial office visit(s) and/or procedure(s). You will need to contact our Business Office to set up payment arrangements for the remaining balance.

Our Business Office staff is available Monday through Friday from 8:30 a.m. to 5:00 p.m. to assist you with any questions you may have regarding your bill. Contact the Business Office at (804) 285-4465.

Monitored Anesthesia Care

Gastrointestinal Specialists will be billing for the administration of MAC (Monitored Anesthesia Care).  The anesthetic is administered by a Certified Registered Nurse Anesthetist under the direct supervision of an anesthesiologist.  Most insurances require the claim to be split between these two providers; therefore, your bill may have the appearance of double billing.  Your insurance company’s payment will be split between these two line items.  We, as always, will adjust off the difference between the charges and your insurance company’s allowable amount for the service.  You will be billed for any remaining balance. Most insurance plans have separate benefits for anesthesia, so you may be responsible for copays, deductibles, and/or a coinsurance amount. Please check with your insurance plan regarding your anesthesia benefits.

Colonoscopy: Screening or Diagnostic?

Your insurance policy may be written with different levels of benefits for preventive versus diagnostic or therapeutic colonoscopy services. This means that there are instances in which you may think your procedure will be billed as a “screening” when it actually has to be billed as therapeutic. How can you determine what category your colonoscopy falls into?

Colonoscopy Categories:

Diagnostic/Therapeutic Colonoscopy: The patient has past and/or present gastrointestinal symptoms, polyps, GI disease, iron deficiency anemia, and/or any other abnormal tests. Any colonoscopy that follows a positive Cologuard test is considered a diagnostic colonoscopy.

Surveillance/High-Risk Screening Colonoscopy: Patient is asymptomatic (no gastrointestinal symptoms either past or present), has a personal history of GI, personal and/or family history of colon polyps, and/or cancer. Patients in this category are required to undergo colonoscopy surveillance at shortened intervals (e.g., every 2-5 years). *While Medicare considers this a High Risk/Screening, most commercial carriers consider it a Surveillance and, therefore, the claim is subject to deductibles and/or coinsurance amounts.

Before your procedure, you should know your colonoscopy category. After establishing which one applies to you, you can do some research with your insurance company in regard to your coverage and what your out-of-pocket expense will be.

Your primary care physician may refer you for a “screening” colonoscopy but there may be a misunderstanding of the word screening. You must have no symptoms at all for your colonoscopy to be billed as a screening service.

Can the physician change, add or delete my diagnosis so that I can be considered eligible for colon screening?

No! The patient encounter is documented in your medical record from the information you have provided as well as what is obtained during our pre-procedure history and assessment. It is a binding legal document that cannot be changed to facilitate better insurance coverage.

Patients need to understand that strict government and insurance company documentation and coding guidelines prevent a physician from altering a chart or bill for the sole purpose of coverage determination. This is considered insurance fraud and punishable by law with fines and/or jail time.

What if my insurance company tells me that the doctor can change, add or delete a CPT or diagnosis code?

Sadly, this happens a lot. Often the representative will tell the patient that “if the doctor had coded this as a screening, it would have been covered differently.” However, further questioning of the representative will reveal that the “screening” diagnosis can only be amended if it applies to the patient. Remember that many insurance carriers only consider a patient over the age of 45 with personal or family history as well as no past or present gastrointestinal symptoms as a “screening.” If you are given this information, please document the date, name, and phone number of the insurance representative. Next, contact our billing department, and we will investigate the information given. The usual outcome is that the rep ends up calling the patient back and explaining that the member services representative should never suggest a physician change their billing of a procedure to anything other than exactly what was done, and why.

Where can I find more information on colonoscopy payments?

The American Gastroenterological Association has released a Guide to Help With Patient Questions About Colonoscopy Payments.