Know Your Insurance Coverage And Requirements
KNOW YOUR INSURANCE COVERAGE FOR COLONOSCOPY
Contact your insurance company. Let the customer service rep know you are having a colonoscopy and the reason for the procedure. Make sure you understand all the answers to your questions. Please let this office know if there is an issue with your colonoscopy coverage. If your insurance company denies benefits to cover your colonoscopy this office can work out a monthly payment plan. The hospital will bill you separately so you may need to discuss those finances with the hospital patient accounts department.
I AM ___YEARS OLD AND AM HAVING A SCREENING/ROUTINE/SURVAILLENCE COLONOSCOPY (different insurances use different terminology)
ACCORDING TO THE AMERICAN CANCER SOCIETY (ACS) GUIDELILNES:
__: Not experiencing any specific GI medical problems
__: No problems but hava a personal history of colon cancer
__: No problems but have a personal history of colon polyp
__: No problems but have a family history of colon cancer (Father, Mother Sibling, Child)
__: No problems but have a family history of colon polyp (Father, Mother Sibling, Child)
I AM ___YEARS OLD AND AM HAVING A DIAGNOSTIC COLONOSCOPY:
__: I am experiencing GI medical problems such as
__: Rectal bleeding
__: Constipation
__: Diarrhea
__: Anemia
__: Abdominal pain
__: Other______________________________
What does my insurance policy cover? Will I have a deductible or balance due?
__: Screening according to the ACS with no symptoms: __Yes __No
__: Screening according ACS with a personal or family history: _Yes __No
__: Diagnositic colonoscopy because of GI problems: __Yes __No
__: Deductible or balance due after insurance payment __Yes __No
ATTENTION ALL UNITEDHEALTHCARE SUBSCRIBERS: If you have a United Health Care Plan you may require an insurance authorization or insurance approval for your colonoscopy. Your insurance may also direct you to the facility where your policy will cover your procedure regardless of your physician affiliation or your choice of facility. Call your customer service dept. (phone number should be on the back of your insurance card. Tell the representative you are having a colonoscopy that will be billed using CPT code 45378 or 45380 or 45385 (depending upon findings at the time of your colonoscopy) and ask if your policy requires a UnitedHealthCare insurance prior authorization. Also tell the representative the facility where your procedure is scheduled. (Dr. Curran does procedures at Charles River Endoscopy Center which is a free standing ambulatory center or UMass Marlboro Hospital Outpatient Endoscopy Center or Marlboro Hospital Outpatient both hospital based facility.) Please then contact Doreen at my office with the customer rep responses as your appointment will need documentation that an authorization for the procedure and place of service is or is not required. If authorization required, Doreen will then contact your insurance for the authorization necessary to confirm the date and place of your appointment and to submit a claim for your colonoscopy.