Policies

Prescription Refill Policy

Our office requires you to come in for an office visit at least once a year if you are on continuing prescription medication. If you have seen us within the year and have no more refills on your medication, please have your pharmacy contact us to request a refill.


Insurance

GastroIntestinal Healthcare accepts most major insurances, including:

  • AARP Medicare Complete
  • Aetna
  • Aetna Duke Select
  • Allied Global Care
  • Assurant Healthcare (Aetna or First Health Network Only)
  • Blue Cross Blue Shield (excluding Blue Value and Blue Local)
  • BCBS Medicare PPO
  • BCBS State Health Plan
  • Cigna/Great West
  • Coventry/First Health Network/Wellpath
  • Ethix Southeast
  • GHI (CBP Network)
  • Healthcare Savings
  • Humana
  • Medcost
  • Medicare
  • Multiplan/PHCS
  • NCSA/Duke
  • One Net PPO
  • Railroad Medicare
  • Tricare/Champus
  • UHC Medicare State Health Plan
  • UMR
  • United Healthcare

We will file our charges directly with your insurance company. If your insurance is not listed, or if you do not have insurance, we will be happy to discuss how we can provide service to you.


HELPING YOU TO UNDERSTAND YOUR MEDICAL TREATMENT TERMS AND NAVIGATING INSURANCE BENEFITS

Colonoscopy: Screening or Diagnostic?

Your doctor has referred you to GastroIntestinal Healthcare (GIH) for a screening colonoscopy, but there may be a misunderstanding of the word “screening”. Before your procedure, our doctor performing the colonoscopy will determine what category of colonoscopy you will be having. With this important information, we will then contact your insurance company and find out what your estimated financial responsibility will be according to your specific policy coverage.

Colonoscopy Categories:

Preventative Colonoscopy Screening Diagnosis: Patient has no gastrointestinal symptoms either past or present. Is 50 or older, has no personal or family history of GI disease, colon polyps, and/or colorectal cancer. The patient has not undergone a colonoscopy within the last 10 years.

Surveillance/High Risk Screening Colonoscopy: Patient does not have gastrointestinal symptoms either past or present. Patient does have either a personal history or family history of GI disease, colon polyps, and/or colorectal cancer. Patients in this category are required to undergo a colonoscopy surveillance at shortened intervals, usually every 2 to 5 years.

Diagnostic/Therapeutic Colonoscopy: Patient has either past and/or present gastrointestinal symptoms, polyps, GI disease, iron deficiency anemia and/or any other abnormal tests.

Common Questions:

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 as a medical record from information you have provided, as well as what is obtained while taking your 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 file for the sole purpose of coverage determination. This is considered insurance fraud and is 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 procedure or diagnostic code? This happens a lot. Often the representative at the insurance company will tell the patient that “if the doctor had coded this as a screening, it would have been paid differently”. However, further questioning of the representative will reveal that the “screening” diagnosis can only be changed if it apples to the patient. Remember that many insurance carriers only consider a patient over the age of 50, with no personal or family history, as well as no past or present gastrointestinal symptoms, as a “screening –V76.51.”

If you are given this information, please document the date, name and phone number of the insurance representative. Next, contact our billing department, who will perform an audit of the billing and investigate the information given. Often the outcome results in the insurance company calling the patient back and explaining that the member services representative should never suggest physicians change their procedure billing for better benefit coverage.

When my insurance company says that I am covered at 100%, does this mean that I personally will have nothing to pay? Sometimes you will have to pay something, depending on your particular policy and benefits. You may still have a deductible amount and/or co-pay/co-insurance after the insurance company has paid the doctor. In that case, the procedure may be covered at 100% – after you meet your co-insurance/co-pays and deductible are applied.


Costs

Most insurances will cover the cost of the procedures, less any co-pays, co-insurance, and deductibles that may apply. As a courtesy to our patients, we provide each patient with a written estimate in advance of their procedure of potential out-of-pocket expenses associated with the procedure and insurance coverage, and un-met deductibles and co-insurance, if applicable.


Dependent upon the actual contract we have with your insurance provider, you may be responsible for the following fees:

  • Professional Fee– which is the doctor’s charge for performing your procedure.
  • Facility Fee– which is the charge for the procedure being performed in our endoscopy center.  (If your procedure is performed at the hospital, the hospital would bill your insurance company for this fee, which is usually higher than if performed in our endoscopy center.)
  • Pathology Fee– if the physician sends a biopsy to the pathology lab, the pathology lab will file their charges directly with your insurance company.  Our estimate does not include any potential pathology fee responsibilities.
  • Anesthesia Fee– is the charge for anesthesia services provided for your procedure.  If applicable, you may receive a separate invoice from Carolina Anesthesia.  Our estimate does not include any potential anesthesia fee responsibilities.

We strongly encourage patients to check directly with their insurance provider if they have questions about their benefits, and to determine whether a referral is required.


Financial Policy

We want to thank you for choosing GastroIntestinal Healthcare as your preferred healthcare provider.  We are committed to giving you the best care available.

Insurance

Your insurance policy is a contract between you and your insurance company.  We are not a part of that contract.  We do accept assignment of your benefits, however please be aware that some or all of the services provided may be a non-covered service under your plan. You will be responsible for these non-covered charges.  It is your responsibility to:

  • Ensure that we actively participate with your insurance carrier/plan
  • Know your benefit coverage
  • Ensure that all pre-approval requirements are met to avoid denials or out-of-network benefits.

Please remember that we must receive your billing information at the time of each visit in order to meet claims submission guidelines set by your insurance plan.  If either the practice or the plan fails to receive accurate information necessary to process your claim, you will be held responsible.

Regarding insurance plans where we are a participating provider, all co-pays and deductibles are due at the time of treatment.  In the event that your insurance coverage relates to a plan where we are not a participating provider, you will be 100% responsible for all charges incurred.

In summary, your financial responsibility pertains to:

  • Denied and non-covered services
  • Services deemed not medically necessary by your insurance company
  • Co-payments, deductibles, co-insurance
  • Pending claims due to lack of patient and/or guarantor information
  • Non-insurance and/or out of network benefits

Please be aware that if your insurance company has not paid within 45 days, your balance may be transitioned to patient responsibility.


Self Pay

Patient must pay in full at time of service.


Financial Services


care-credit

CareCredit is a healthcare credit card designed for your health and wellness needs. Through the CareCredit program, GIH offers a 6-month, no interest payment plan option for balances over $200. For complete details of healthcare financing terms, please click on this CareCredit  link and review the CareCredit account agreement within the application.


Missed Appointments

Please provide us with a 24 hour notice of cancellation so that we may utilize our schedule to provide better patient care.  If you don’t offer at least 24 hours advance notice, we may charge you a $25.00 missed appointment fee.  This charge will not be billed to your insurance company.  Please be advised that if you miss two appointments without providing notice, you will be required to pay a $100 scheduling fee for future appointments.  This fee will be applied toward the cost of your appointment.  If you miss your appointment and do not provide required notice, this scheduling fee will be forfeited.


Collections

Any past due balances not paid may be turned over to a collection agency after 45 days.