Patient Billing Explanation
You are scheduled to have an endoscopic procedure at Eastside Endoscopy Center. The procedure will be performed by one of the GI Medicine physicians. During the procedure you will receive sedation administered by one of the Eastside Group LLC anesthesiologists/CRNA's (Certified Registered Nurse Anesthesiologist).
Frequently during the endoscopy your doctor will take a biopsy(s). If a biopsy is obtained, the specimen will be processed at either at the GI Medicine Histology Lab or St. John Hospital and will be interpreted by one of the pathologists from Pathology Specialists of Southeast Michigan.
Your procedure will generate the following different charges to your insurance or to you, if you do not have insurance:
- Professional Fee: This is the fee from the GI Medicine physician that performed your procedure. If you have questions regarding the physician fee, please call GI Medicine Associates at 586-498-0280.
- Facility Fee: This is the fee from Eastside Endoscopy Center where your procedure is going to be performed. If you have questions regarding the facility fee, please call the Eastside Endoscopy Center at 586-447-5113.
- Anesthesia Fee: This is the fee from Eastside Group for the services provided by the anesthesiologist or CRNA. If you have questions regarding the anesthesia fee, please call Anesthesia Revenue Management at 586-838-5034.
- Histology Lab Fee: This is the fee from GI Medicine or Pathology Specialists of Southeast Michigan for processing the biopsy.
- Pathology Fee: This is the fee from Pathology Specialists of Southeast Michigan for the interpretation of the biopsy by one of the pathologists. If you have questions regarding the pathology fees, please call Pathology Specialists of Southeast Michigan at 800-535-3074.
How to read your insurance statement:
Your insurance statement, (EOB), sometimes can be confusing. The following information may help you to understand this document:
- Total Charges: This is the amount that the provider charges the insurance. THIS IS NOT THE AMOUNT OF MONEY THAT THE PROVIDER EXPECTS TO COLLECT.
- Allowed Amount: This is the total amount that the provider is expected to receive from insurance and/or patient combined. (It is also called the negotiated amount or expected amount).
- Payable amount: This is the amount that the primary insurance will pay.
- Patient responsibility: This is the difference between the allowed amount and the payable amount. This represents the deductibles and co-payments. If you have a secondary insurance they may pay for all or part of the "patient responsibility", depending on your contract.
Issues related with screening colonoscopy:
What is a screening colonoscopy? A screening colonoscopy is a colonoscopy that is performed in order to find out if the patient has colon polyps or cancer. It is not a colonoscopy that is performed to explain the patient's symptoms (i.e. blood in stools, changes in bowel movements, etc.).
Medicare will cover screening colonoscopies. Medicare will not apply the deductible to screening colonoscopies but will apply the co-payment.
Most of the private insurances will cover screening colonoscopies, but there are a few insurances and contracts that will not cover screening procedures like colonoscopies.
If a Medicare patient is scheduled for a "screening colonoscopy" and during procedure a polyp is found or the physician needs to take a biopsy, this procedure is no longer considered screening. Medicare requires that we now bill as a non-screening (diagnostic) colonoscopy. In this situation, the patient now becomes responsible for the deductible if it has not been met.
We are legally obligated when we bill Medicare and private insurance carriers, to follow their billing policies based on the medical information available to us. Not following Medicare rules will be considered fraud and will expose us to significant penalties.
Please call the numbers listed above if you have any questions regarding your bill - we will be happy to help you.