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Austin Gastroenterology and the Austin Endoscopy Centers participate with most major insurance carriers. Please check with your member services department to verify your coverage and Austin Gastroenterology's participation status.
All physician’s office schedulers should advise the patient that they may be expected to pay a facility fee when they arrive at the Austin Endoscopy Center in addition to the professional fee they may have paid at their physician's office. This anticipated co-insurance is determined as follows:
- For PPOs, the Center will collect any outstanding deductibles plus the co-insurance for each procedure.
- For all HMOs there will be no facility fee collected unless otherwise stated in your policy.
- For Private Pay (or self-pay) patients, the Center will offer a discount of 50% for all procedures, IF paid at the time of service.
The endoscopy centers accept cash, check, American Express, Visa, Discover and Master Card.
Before your initial visit to Austin Gastroenterology, please see our financial policy.
The Austin Endoscopy Center Business Office routinely files all necessary claims to insurance companies for reimbursement. The patient, however, is ultimately responsible for payment of the bill. It is extremely important that the Austin Endoscopy Center be given all the information regarding the patient’s insurance as soon as possible so that the Business Office can verify that it is in effect and determine the nature of coverage.
If insurance coverage is insufficient, payment for services rendered is due by one of the following means:
- Payment made before or upon admission
- Payment made during Center stay
- Cash or other payment upon discharge
Payment or co-insurance may be made with cash or credit card such as Master Card, Visa, American Express or Discover. Inquiries regarding payment or deposit requirements for your services may be discussed with a Business Office Representative.
Medicare requires that your Center admission and procedure be justified as a medical necessity or Medicare will not pay for your care. You have the right to appeal any written notice that states Medicare will no longer be responsible for your bill. Please ask your nurse to have someone from the Administration/Billing to contact you if you wish to appeal a Medicare denial decision.
Austin Endoscopy Center is aware that bills are sometimes difficult to understand because of the various requirements imposed on the Center by health insurance carriers. Your statement of account will include only those services rendered to you by Austin Endoscopy Center. Services provided by your doctor / anesthesiologist, pathologist and laboratory will be billed by their respective offices. If you wish to have your statement of accounts clarified, you may call the Administrative Business Office (512) 420-0186.
Most insurance plans do not cover 100 percent of your visit. You may be expected to pay a facility fee co-insurance (depending on your insurance) prior to your procedure. If you are unable to pay the balance in full, you may make arrangements for installment payments by speaking with the Medical Office Manager or by calling the Administrative Business Office (512) 420-0186.
SB 1467 – Who’s Covered?
Question and Answer
Click here to Read Senate Bill 1467
Q. Who’s covered?
A. Any person 50 years of age or older, with insurance coverage through a commercial health benefit plan governed by the State of Texas, who is at normal risk for developing colon cancer, is covered by SB 1467 and 28 TAC §§ 21.2101 – 21.2106. The mandated benefit is valid for commercial health benefit plans delivered, issued for delivery, or renewed on or after January 1, 2002. Patients should contact their health benefit plan to verify that the mandated benefit applies to them and that the coverage exists prior to the procedure. ****The Law does not cover ERISA plans, Medicare, Medicare+Choice, Medicaid, Workers Compensation Products or small employer plans written under Chapter 26 of the Texas Insurance Code.****
Q. What is covered?
A. The covered individual (as defined above) may choose a medically recognized screening examination for the detection of colorectal cancer. The choices include:
a) A fecal occult blood test performed annually and a diagnostic flexible sigmoidoscopy performed every five (5) years or,
b) A screening Colonoscopy performed every 10 years.
Q. I’m covered by an HMO. Our company’s human resources director says the law doesn’t apply to the HMO because our specific policy does not include screening benefits.
A. Unfortunately, this may be the case - for plans that were in effect before January 1, 2002. If a particular company negotiates lower premiums in return for less covered benefits, screening tests may not be covered. However, when it comes time for your plan to be renewed, it is our understanding that they must offer the benefits mandated by SB 1467. Nonetheless, you may wish to speak to your HR director and make sure that this is renegotiated when the policy renewal period is up. The prevention of colon cancer is far less costly than treating the disease once someone is far enough along to have symptoms of colon cancer.
Q. The company I work for is self-insured – does the bill apply to me?
A. Unfortunately, there is no current state or federal law mandating this benefit for self-insured health plans. However, United States Senate Bill 710 and House Resolution 1520 have been introduced in the US Congress to mandate these benefits for self-insured health plans currently governed by the Employee Retirement Income Security Act of 1974 (ERISA). Call your US Congressman and ask them to support this important legislation.
Q. I’m insured with a PPO and my policy does cover screening benefits; however, the insurance company won’t give the doctor’s office pre-authorization for the Colonoscopy because they say they only pay for flexible sigmoidoscopy.
A. Unless your policy specifically excludes certain screening benefits, the law says that the patient has the right to choose whether to be screened with the flexible sigmoidoscopy every 5 years or Colonoscopy every 10 years. And again, when your policy comes up for renewal after January 2, 2002, Colonoscopy must be an option. You might give them a copy of this or refer them to the Texas Department of Insurance if they have further questions. You should, however, still get pre-authorization before doing the procedure, so that you are not liable if the insurance company refuses to pay. It may take a while before all insurance companies are aware of the changes in the law.
Q. I’m covered by Medicaid – does SB 1467 apply to me?
A. No, the bill does not apply to Medicaid patients. Medicare patients, however, are covered under similar federal legislation – thanks to changes in Medicare coverage that went into effect on July 1, 2001. These allow an individual at normal risk over age 50 to receive a screening Colonoscopy every 10 years or flexible Sigmoidoscopy every 48 months.
© 2003 Austin Gastroenterology * Updated