Insurance & Claims
We participate in most insurance plans offered by major insurance carriers. Learn about our claims processing, billing, financial policy, and the difference between screening and diagnostic colonoscopies below.
We recommend checking with your insurance carrier regarding in-network providers and your coverage. You might find a phone number on the back of your insurance card that you can call for more information.
We continuously evaluate our contracts with insurance carriers to provide you with the best in-network options. We currently participate in plans with the following insurance providers.
Aetna
Bay Area Hospital
Care Oregon
Cigna
First Choice Health
First Health
Health Net
Humana
Kaiser
Marquis
MODA
Most Oregon Medicaid products
Multiplan/PHCS
PacificSource
Providence Health Plans
Providence Preferred
Regence
Tricare
Trillium
United Healthcare
Knowing your coverage will help you avoid unanticipated bills and frustration. Some things you should verify include:
- Copayment (This amount can be different based on the service you are seeking.)
- Patient deductible
- Requirements for referrals
- Pre-existing clauses (i.e. coverage rules for a pre-existing condition)
- Prescription benefits
- Covered and non-covered services
One of our billing specialists will handle your claim, from start to finish. They are highly effective in their communications with insurance companies to ensure proper payment of your claim. After you receive a service from our practice, we will send a medical claim to your insurance carrier. Once your claim has been processed, we receive an explanation of benefits (EOB) from your carrier that reports the payment made, as well as any balance due from you. We review the EOB for accuracy and process the claim appropriately in our system. If your insurance company reports that a patient balance is due and you have not already paid that balance, we will send you a statement.
We have established our financial policies so that you can be informed and plan accordingly. We welcome any questions you might have. Read our Patient Financial Policy. Our Patient Financial Services department is available to assist you Monday-Friday, 9am to 5pm. Please call 541-868-9502 with any billing questions.
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 must be billed as “therapeutic.” Before your procedure, you should know your colonoscopy category. Below is a description of each to help you determine which best describes you and the colonoscopy you’ll receive.
Diagnostic/Therapeutic Colonoscopy: Patient has past and/or present gastrointestinal symptoms, polyps, GI disease, iron deficiency anemia and/or any other abnormal tests.
Surveillance/High-Risk Screening Colonoscopy: Patient is asymptomatic (no gastrointestinal symptoms either past or present), has a personal history of GI disease, colon polyps, and/or cancer. Patients in this category are required to undergo colonoscopy surveillance at shortened intervals (every 2-5 years, for instance).
Preventive Colonoscopy with Screening Diagnosis: Patient is asymptomatic (no gastrointestinal symptoms, past or present), over the age of 50, has no personal or family history of GI disease, colon polyps, and/or cancer. The patient has not undergone a colonoscopy within the last 10 years.
After establishing which one applies to you, you can do some research with your insurance company related to your coverage and your out-of-pocket expense. Your primary care provider may have referred you for a “screening” colonoscopy, but the word “screening” is easily misunderstood. You must have no symptoms at all for your colonoscopy to be billed as a preventive service. Also, keep in mind that not all insurance providers include preventive colonoscopies as part of your preventive benefit.
Q: Can the physician change, add or delete my diagnosis, so that I can be considered eligible for colon screening?
A: No. The patient encounter is documented in your medical record from information you’ve provided, as well as what’s obtained during our pre-procedure history and assessment. It is a binding legal document that cannot be changed to facilitate better insurance coverage. Please 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.
Q: What if my insurance company tells me that the doctor can change, add or delete a CPT or diagnosis code?
A: Sadly, this happens. Insurance representatives have been known to tell patients: “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. Many insurance carriers only consider a patient over the age of 50 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 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 explain why.
Are you confused because you received two bills? The facility bill is separate from the specialist’s bill. The providers of Eugene Gastroenterology are independent providers who are not employees of the facility or hospital. A bill will be submitted by Eugene Gastroenterology for professional physician services. The facility or hospital bill is from the location where your care took place. This charge includes the supplies, equipment and/or technician services required to perform your procedure. You can pay your bills by mail or use our online bill pay.
