EL CAMINO GI MEDICAL ASSOCIATES
CROHN'S & COLITIS MEDICAL CLINIC
Understanding your Financial Responsibilities
Introduction to New Health Insurance Policies
Due to the rising cost of health insurance, health plans are currently offering many new policies to make health insurance rates more affordable for employers and employees. These insurance policies require patients to contribute more to the cost of their care through higher co-payments and larger annual deductible amounts before insurance coverage takes over. These fees are independent from your health insurance premiums.
Why may I receive a bill from more than one source?
When a physician performs a procedure, there are separate and independent provider costs for that procedure.
· Physician Fee
· Facility Fee
· Pathology Fee
· Anesthesiology Fee
If you have concerns about the charges relating to your procedure date, please contact our billing office and they will be happy to explain the fees incurred.
When should I be Prepared to Pay?
It is your responsibility to know if your insurance requires referrals, co-pays, deductibles or co-insurance cost. Information about your plan can be obtained from your HR department, the plan website or by calling the member services number on the back of your card.
· Co-Payments are expected at time of service. The amounts should be clearly visible on your health insurance card.
· Deductibles and co-Insurance amounts, when advised, will also be collected at the time of service.
We accept cash, checks, money orders and all major credit cards.
Telephone
It is your responsibility to know if your insurance requires referrals, co-pays, deductibles or co-insurance cost. Information about your plan can be obtained from your HR department, the plan website or by calling the member services number on the back of your card.
· Co-Payments are expected at time of service. The amounts should be clearly visible on your health insurance card.
· Deductibles and co-Insurance amounts, when advised, will also be collected at the time of service.
We accept cash, checks, money orders and all major credit cards.
No-Show/Late Cancellation Policy
El Camino GI Associates reserves the right to charge a fee for appointments that are NOT KEPT or CANCELLED with less than 24 hours’ notice.
· Office Visits will be subject to a $50 fee.
· Procedures will be subject to a $200 fee.
What is a deductible?
A deductible is an annual expense a patient pays before a health plan begins to cover your healthcare expenses. For example, each year you may be responsible for paying the first $1000.00 of the expense before your health plan coverage begins to make payments. This is your shared cost of your insurance.
What is a copay?
A copay is a specific amount a patient pays for a service. For example, a $25 copay for an office visit with a specialist.
What is a co-insurance?
A co-insurance is a percentage of a health care expense for which a patient is responsible for paying. For example, your health insurance may pay for 80% of the cost and the patient is responsible for 20% of the cost. This is your responsibility for costs after your insurance deductible is met.
What is a non-covered service?
A co-insurance is a percentage of a health care expense for which a patient is responsible for paying. For example, your health insurance may pay for 80% of the cost and the patient is responsible for 20% of the cost. This is your responsibility for costs after your insurance deductible is met.
When should I be prepared to pay?
It is the patient’s responsibility to know if your insurance has any copays, co-insurances and/or deductibles. Information about your plan can be obtained from your HR department, the plan website or by calling the member services on the back of your insurance card. The patient should be prepared to pay at the time of service. You may be notified by our billing agency by phone and/or letter with an approximate amount due at the time the service is rendered.
Who will be billing me and/or my insurance carrier?
When a physician performs a procedure, there are separate and independent providers who may be involved in your care. Costs from these necessary additional providers may occur with your procedure. These may include the Physician Fee, Facility or Hospital fee, Pathology fee, Anesthesiology fee. If you have any questions on who may be involved with your care, we are pleased to review this with you prior to your procedure. Please call 650-988-7488.
What is a referral?
A referral is generated by your PCP’s office to the specialist. It is the patient’s responsibility to know if your insurance requires a referral and it is the patient’s responsibility to obtain that referral if needed from your PCP’s office. If a referral is not obtained within 48 hours, your appointment may be cancelled.
What is a prior authorization?
A prior authorization for a service is one that needs to be approved by your health plan prior to receiving that service. Prior authorization is the responsibility of the provider. Our billing service will contact your plan to obtain the prior authorization.
What is a screening colonoscopy?
A colonoscopy is done in the absence of symptoms or abnormal testing.
What is high risk screening colonoscopy?
A high-risk screening colonoscopy is when a patient has a family history of colon cancer in a first degree relative, also patients with genetic disorders and long-standing inflammatory bowel disease. A personal history of colon polyps is not considered a high-risk screening with most insurance carriers.
Can a Physician change, add or delete a diagnosis so that I can be eligible for a colonoscopy screening?
No. This is insurance fraud.
What is an ABN?
An ABN is an Advance Beneficiary Notice, also known as a waiver of liability. The ABN allows you to decide whether to get the care in question and to accept financial responsibility for a service that is not covered under your insurance plan.
Who should I contact with questions?
Any billing related questions can be addressed with our billing company by calling 650-988-7181.
What facilities may bill me?
If your outpatient procedure is being performed at the ambulatory facility, you may receive a bill from the Endoscopy Centers listed below. If you have any questions as to what your out-of-pocket costs are for the facility fee, please contact the facility directly. They will be able to assist you.
· Mountain View Endoscopy Center Scheduling Office 650-988-7487.
If your outpatient procedure is being performed at a Hospital, you may receive a bill from one of the Hospitals listed below.
· El Camino Hospital: 650-988-7181
· Stanford Hospital: 1-800-549-3720