Insurance and Billing

Accepted Insurance Policies

We participate with Medicare, Medicaid, Tricare and most major insurance companies.  As a service to you, we will gladly file your claims with your insurance carrier.  If you would like to confirm that we participate with your insurance carrier or network, please contact our Business Office at (804) 330-4901 prior to your appointment.

Insurance coverage is a contract between you and your insurance carrier. You may want to contact your insurance carrier in advance to verify coverage and benefits to which you are entitled.

If you do not have medical insurance, a deposit will be required prior to your first office visit and / or procedure.  Payment arrangements for any remaining balance can be made by contacting our Business Office at (804) 330-4901.

Referrals

If you are enrolled in a HMO plan, please contact your insurance carrier to determine whether a referral is required prior to seeing a specialist.  If so, it is your responsibility to work with your primary care provider to obtain the referral from the insurance carrier.  (If your insurance carrier refuses to apply benefits to your claim because of failure to obtain a referral, you would potentially be held financially responsible for the cost of the specialist’s services.)

Co-Payments/Deductibles

If your insurance policy requires a co-payment for an office visit with a specialty provider, please be prepared to make any required co-payment or unmet deductible amount at the time of your visit.  To make it as easy as possible for you, we accept personal checks, cash, and most major credit cards.

Procedures at Virginia Endoscopy Center

We do many of our endoscopy procedures in our office at the Virginia Endoscopy Center (Northside at Staples Mill and Southside at Wadsworth). Virginia Endoscopy Group is one of our offices and NOT an ambulatory surgery center or outpatient facility.  Before your procedure, please contact your insurance carrier to verify your coverage and benefits for office-based procedures.

Several claims will be submitted for your procedure.  The procedure, anesthesia, and pathology (if tissue samples require evaluation) are billed separately.  Some insurance carriers require that two anesthesia claims be submitted for Monitored Anesthesia Care — one for the CRNA who administers the anesthesia and one for the anesthesiologist supervision of the CRNA.

IF YOU ARE HAVING A COLONOSCOPY, PLEASE READ THE NEXT SECTION.

Is My Colonoscopy Preventative or Diagnostic:  What You Need to Know

The Affordable Care Act requires that recommended preventative services such as colonoscopies be covered at no cost to the patient.  However, strict guidelines are used by insurance companies to determine whether a colonoscopy is categorized as preventative or diagnostic.

Preventative Colonoscopy Screening:  Patient is asymptomatic (no present gastrointestinal symptoms), is age 50 or older, and has no personal history of gastrointestinal disease, colon polyps and/or cancer. A colonoscopy has not been performed within the past ten years.

Surveillance / High-Risk Colonoscopy:  Patient is asymptomatic (no present gastrointestinal symptoms) and has a personal history of gastrointestinal disease (such as diverticulitis, Crohn’s disease or ulcerative colitis), colon polyps and/or cancer. Shorter intervals between colonoscopies are recommended for these patients (usually every 2 – 5 years). Some insurance carriers consider surveillance / high-risk colonoscopies to be preventative, while others consider them to be diagnostic.

Diagnostic / Therapeutic Colonoscopy:   A colonoscopy is performed to evaluate or treat gastrointestinal symptoms, colon polyps or gastrointestinal disease.

BEFORE THE PROCEDURE, YOU SHOULD KNOW YOUR COLONOSCOPY CATEGORY.  Please obtain the pre-procedure diagnosis code (reason for the procedure) from the scheduler or medical assistant and contact your insurance carrier to determine:

  • Is a colonoscopy procedure with this diagnosis (provided by scheduler or medical assistant) covered under my policy?
  • If so, will the diagnosis be processed as preventative or diagnostic?
  • If my procedure will be diagnostic, will the allowable amount be allocated to my deductible?  Once the deductible is met, will any additional amounts be allocated to coinsurance?
  • Please note:  If your procedure will be performed at our Virginia Endoscopy Center location, then be sure to tell your insurance carrier that the procedure will NOT be performed in an outpatient setting.

If the procedure will be considered as diagnostic and the allowable amount will be allocated to your deductible, please contact our Business Office at (804) 330-4901 for an estimate of what you can expect to pay.

Please understand that our physicians cannot change the primary diagnosis for the sole purpose of coverage determination.  The diagnosis must be an accurate reflection of your medical history and the information you provide during our pre-procedure assessment.  This is a regulatory requirement imposed by both government agencies and insurance companies with whom we are under contract.

Updates to Your Insurance

Please notify our Business Office if:

  • Your insurance carrier or coverage changes.
  • Your address changes.
  • You are experiencing financial difficulties that prevent you from paying your account when due.
  • You have any other billing questions or concerns.

You can notify our Business Office by phone at (804) 330-4901 or by mail:

Richmond Gastroenterology Associates, Inc.
Business Office
107 Wadsworth Drive
N. Chesterfield, VA 23236