Insurance and Billing

Insurance

We participate in most health plans and file insurance forms provided we have your insurance assignment on file. It is the patient’s responsibility to pay any deductible, co-pay, co-insurance or any amount not paid by the health plan. If we do not participate with your primary insurance plan, full payment is requested at the time of service for physician charges. As a courtesy we will submit a claim to your insurance for all charges incurred, however you are responsible for paying all charges within 30 days of service regardless of what your insurance covers.

Non-insured patients are responsible for all charges at the time of service.

At the time of your visit, patients need to provide the front desk with the correct insurance information, including your insurance card to be copied. Patients will be responsible for full payment of any co-payments, co-insurance and deductibles required by their insurance company.

Your insurance coverage is an agreement between you and your insurance company. Financial responsibility rests with the patient for deductibles, co-insurance and non-covered services. It is very important for you to be aware of the requirements of your health insurance policy so that you will save out-of-pocket expenses and frustration later. Our staff tries to be helpful, but we cannot know everything about the hundreds of insurance plans available to our patients. If you have questions about your benefits, call your insurance company’s member services department (listed on the back of your insurance card) or your employer’s human resources department.

Managed care plans in particular have many rules that you and your physician must follow. For example, you will most likely need a referral or authorization from your primary care physician (PCP) before you see a specialist or have testing done. Failure to do so could leave you responsible for charges. In most cases, the insurance company will not allow your PCP to authorize the visit retroactively. When your physician gives you a written order for testing or refers you to another specialist, do not assume that these services have been cleared through your insurance plan. Your physician is simply practicing good medicine, and may not be aware of your insurance requirements.

It is your responsibility to obtain any referrals that may be required. When you are given a written referral, remember to take it along to your appointment; otherwise, the referral provider is not authorized to see you. Without a referral, you may have to reschedule the appointment or sign a financial waiver accepting responsibility for any charges.

If your insurance requires authorization for an office visit, please contact your referring physician for that authorization prior to calling for an appointment.

If you have any questions or would like to see if we are able to accept your insurance policy, please feel free to contact us.

Our accepted insurances include:

Billing

We will perform courtesy billing for you, provided you have given us all pertinent billing information.

We also offer the option to pay bills online. To learn more about our secure online bill pay option, click here.

About the Business Office

The Business Office’s primary function is to file claims on your behalf to your insurance carrier. Our patient account representative will follow up and file appeals as necessary and are here to help you with any questions you have regarding the processing of your insurance claim.

Benefits Verification

As a courtesy to you, we verify your insurance coverage prior to your endoscopic procedure. Approximately 1 week before your procedure, you may receive a phone call from Jessica or Cristina regarding any deposits that are due at the time of service. This amount is determined by your insurance policy.

Procedure Authorizations

It is the patient’s responsibility to obtain any referrals that may be required. When you are given a written referral, remember to take it along to your appointment; otherwise, the referral provider is not authorized to see you. Without a referral, you may have to reschedule the appointment or sign a financial waiver accepting responsibility for any charges.

Understanding Your Bill

Because MGA provides so many services for patients in-house, you may receive a few different bills.

Office Visits

For an office visit, you will receive charges from Metropolitan Gastroenterology Associates for the professional services of your physician. The level of service and associated charges are determined by the physician based on your needs, medical history, and the nature and complexity of your condition. You will also receive charges for injections and medication if they were administered. If you are covered by a health plan in which we participate you will typically only receive a bill for these services if your co-pay was not paid during your visit.

Endoscopy

Because patients are sedated and must be monitored carefully, an endoscopic procedure (such as EGD or colonoscopy) is done in an outpatient setting either at a hospital or outpatient endoscopy center. For cost-savings and convenience, your physician will likely perform the procedure at MGA Gastrointestinal Diagnostic and Therapeutic Center which is a Medicare-certified, accredited ambulatory surgery center (ASC).

Physician’s Fee

You will receive charges for your physician’s services (the fee for the physician actually performing the procedure) from Metropolitan Gastroenterology Associates. You are expected to pay your unpaid deductible and co-pay on the day of your procedure. You will receive a bill for any unpaid portion of your procedure.