Billing & Insurance Information
Financial Policy (updated 4-2010)
To reduce any misunderstanding or confusion our practice has adopted the following financial policy. If there are any questions regarding our policy, please discuss your concerns with our billing staff. We are dedicated to providing the best possible care and service to our patients and regard their understanding of financial responsibility as an essential element of quality care and treatment.
An extremely important factor that our patients need to be aware of is that there are two fees charged when a procedure is performed - one from the doctor and one from the surgical facility.
Charges from the Center for Digestive Health and Nutrition are strictly for the services provided by the physician also known as the Professional Component.
There is a second fee that will be charged by the facility in which a procedure is performed such as Sewickley Valley Hospital, UPMC Cranberry, Ohio Valley General Hospital or Three Rivers Endoscopy Center. This is known as the Facility Fee which is the fee charged for the room, equipment, medication, nursing staff and material etc.
Please be aware of this when you receive statements from two locations for the same service. It is not considered double billing as some have referred it.
You may notice that if you have a biopsy taken during a procedure you may also receive a statement or explanation of benefits (EOB) regarding charges from a pathology laboratory, usually Heritage Valley Health Systems, Dianon Systems, Quest Diagnostics, Ameripath, or Caris laboratories.
If a procedure is performed, anesthesia services are provided by Western Pennsylvania Anesthesia Associates and a separate explanation of benefits will be generated.
Unless other arrangements have been made in advance, either by the patient or their health insurance carrier, we will expect payment at time of service. For patient's convenience, we accept VISA, American Express, Discover, and MasterCard as well as cash and personal checks.
Insurance
We have made prior arrangements with most insurance companies, as other medical plans to accept assignment of benefits. We will bill those plans for which we have an arrangement and will only require our patients to pay the authorized co-payments, deductibles, or coinsurance at the time of service. It is our office policy to collect all co-payments and deductibles on the day of the appointment.
If the patient has insurance coverage with a plan with which we do not have a prior arrangement, we will prepare and send a claim form on an unassigned basis. The insurance company will directly pay the patient who is responsible for remitting payment to the Center for Digestive Health and Nutrition and Three Rivers Endoscopy Center. All charges will be the responsibility of the patient and 50% paid at the time of service.
In the event that the patient's health plan considers service to be a "non-covered" service, the patient will be responsible for the entire charge. Payment will be due at the time of service.
We will bill the patient's health plan for physician services in the hospital. The same financial responsibilities apply.
Participating Insurance Plans
We have agreements with the following insurance carriers. Many plans may not be listed due to their size, location, or affiliation with other plans. We highly encourage all patients to contact their employer benefits department or the member services department of their insurance carrier for the most accurate participating information. This list can change at any time.
- Advantra (not Ohio Valley Hospital)
- Advantra Freedom
- Aetna Health Plan (not accepted by UPMC Cranberry)
- Blue Shield/Blue Cross (Highmark)
- Blue Shield Special Care (Not Three Rivers Endoscopy Center fee for service)
- Bravo Health (formerly Elder Health)
- Carelink (Advantra WV & OH)
- Cigna
- Community Blue
- Devon
- DPA Medicaid (PA only)/ Medical Assistance
- Freedom Blue
- Preferred Blue
Direct Blue
- First Health Network
- Gateway Health Plan (not accepted by UPMC Cranberry)
- Gateway Health Plan Medicare Assured (not accepted by UPMC Cranberry)
- Health America
- Health Assurance
- Health Net Federal Services / Tricare
- Highmark Services
- Intergroup
- Keystone Health Plan
- Mail Handler's
- Medicare (Highmark Medicare Services (CMS)
- Multiplan
- PPO Blue
- Premier Blue
(Not Three Rivers Endoscopy Center fee for service)
- Private Healthcare System
- Prudential
- Railroad Medicare (Palmetto GBA)
- Security Blue
- Select Blue
- Unison (formerly MedPlus) (not accepted by UPMC Cranberry)
- Unison Advantage
- United Healthcare
- UPMC Health Plan
(Not fee for Three Rivers Endoscopy Center, Ohio Valley Hospital, or UPMC Heritage Valley)
- UPMC For You (Formerly Best Health Care)
(Not Three Rivers Endoscopy Center fee for service)
- UPMC For Life (Medicare HMO)
(Not Three Rivers Endoscopy Center fee for service)
- UPMC For Life Specialty Plan
- UPMC Advantage
(Not Three Rivers Endoscopy Center fee for service)
- US Healthcare (Plan specific)
Patient Appointments
We make every effort to schedule non-emergency appointments within a reasonable amount of time. Patients who are sick or have a serious problem may often be seen on the same day. To accommodate all situations, we ask that patients call our office promptly if they are unable to make an appointment or have the need to reschedule to avoid a cancellation fee.
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