Patient Forms
Frequently Asked Questions
Colonoscopy
If anything changes in your MEDICAL CONDITION or your MEDICATIONS, or you have recently been sick or in the hospital or ER, please contact your physician to let him/her know before you come to your procedure.
Colonoscopy: What you Need to Know!
The Affordable Care Act (ACA) passed in March 2010 allows for several preventative services, such as a screening colonoscopy, to be covered by your insurance company with no out-of-pocket costs to you. However, each insurance carrier has different benefit guidelines for colonoscopies and there are many situations where out-of-pocket costs apply.
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Colonoscopy Categories
- Diagnostic/Therapeutic Colonoscopy: Patient is currently having gastrointestinal (GI) symptoms, has known polyps, or gastrointestinal problems/diseases. This service is NOT considered preventive and is NOT included in the provisions of the ACA.
- Surveillance/High Risk Screening Colonoscopy: Patient is asymptomatic (no GI symptoms), but does have a personal history of GI disease, colon polyps, and/or cancer. Patients in this category are required to undergo a colonoscopy at shortened intervals (e.g. every 5 years or sooner). Medicare covers colonoscopies for high risk patients every two years. Most insurance companies consider this a surveillance colonoscopy therefore applied to your deductible and co-insurance.
- Preventive/Screening Colonoscopy: Patient is asymptomatic (no GI symptoms), age 50 or over, has no personal history of GI disease, colon polyps, and/or cancer. The patient has not undergone a colonoscopy within the last 10 years. This service may be covered under the ACA.
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Amounts. It is important to know that your insurance company may not consider your colonoscopy. For all colonoscopy categories, you should be prepared to pay an amount up to your deductible, plus any applicable co-insurance a “screening colonoscopy.” Please check with your insurance company before your procedure and be sure to ask about your out-of-pocket cost, should your colonoscopy not be covered as “screening.” Preparing for a variety of insurance coverage scenarios can help avoid unpleasant surprises, after-the-fact.
Can the physician change, add or delete my diagnosis code so that I can be considered a screening colonoscopy patient? No. The patient encounter is documented as a medical record from information you have provided as well as an evaluation and assessment from the physician. It is a binding, legal document that cannot be changed, per governmental, insurance and compliance guidelines to facilitate better insurance coverage. This is considered insurance fraud and punishable by law.
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Why am I charged for sedation/anesthesia services, when I wasn’t a few years ago?
Our goal is to provide you with the safest and most effective anesthesia for your procedure. Therefore, we only use Anesthesiologists (MDs) and/or Certified Nurse Anesthetists (CRNAs) to administer anesthesia to our patients. Your insurance carrier will be billed for professional anesthesia services provided by the anesthesiology providers (MDs or CRNAs).
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