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(919) 854-2500

Insurance & Billing

Carolina Gastroenterology accepts most major insurances at its three locations, including:

  • Aetna
  • America's 1st Choice
  • Blue Cross Blue Shield
  • CIGNA HealthCare
  • First Health
  • Humana
  • MedCost
  • Medicare
  • Multi Plan
  • Partner’s Medicare
    Advantage
  • PHCS
  • Private Pay
  • Tricare
  • United HealthCare
  • Wellpath

If your insurance is not listed, or if you do not have insurance, we will be happy to discuss payment arrangements.

Costs

Most insurance will cover the cost of the procedures, less any co-pays, co-insurance and deductibles that may apply. Each insurance plan is different so be sure to check with your plan in advance.

Depending on our contract with your particular carrier your procedure could result in a combination of the following fees:

  1. 1. A professional fee – this is the doctor’s charge for performing the procedure.
  2. 2. A facility fee – this is the charge from the center.
  3. 3. A pathology fee – if a biopsy is needed, you will be billed separately for these services.
  4. 4. An anesthesia fee – this is the charge for anesthesia services.

Carolina Gastroenterology and your doctor’s office will file their charges directly with your insurance company. At the time of your procedure, you may be responsible for paying the co-insurance and/or deductibles that your insurance plan requires.

If your health plan pays for a screening benefit, and the procedure uncovers abnormal findings, we are required to file the charges as a “therapeutic” procedure, not as a screening procedure. This may result in co-insurance and deductible responsibility on your part.

As an important note, out of pocket costs at our center are usually lower than having the procedure done at a hospital.

Our Medicare patients will be responsible for their Part B deductible and/or coinsurance on the Medicare approved amount for the services.

Carolina Gastroenterology accepts cash, checks and most major credit cards.

Billing Policy

Patients are responsible for the cost of services rendered. If your insurance company requires pre-authorization for your procedure, please notify your physician when it is scheduled as this must be done in advance. As a courtesy to our patients and to help them meet their financial obligations, the center will bill their health insurance carrier(s) for them, provided a valid I.D. card and/or information regarding insurance coverage is presented on or before the time of registration.

The procedure for which you are scheduled generates a facility fee for the use of the surgery center. This fee includes all medications, IV supplies, endoscopy equipment, nursing care, etc. Additionally you will be billed for the physician’s services and any lab charges associated with your visit separately.

Carolina Gastroenterology accepts assignments of benefits and maintains an active follow up process with all health insurance carriers. Many insurance companies have additional benefits for screening colonoscopies. If during a screening colonoscopy abnormal findings such as a polyp or lesion is detected and removed, the service then becomes therapeutic. While we always try to minimize any out-of-pocket expense for our patients, we must comply with these mandates so please verify these benefits with your insurance carrier.

Unpaid balances, including all applicable co-payments, deductibles and any non-covered services are the responsibility of the patient and must be paid within 30 days of receipt of the statement. An account will be considered delinquent if payment arrangements are not made within the 30 days allowed. We cannot waive amounts defined as patient responsibility as such waiver may violate state and federal laws. Additionally, we ask our patients to contact their insurance carriers for payment status if their account remains unpaid after 45 days. Carolina Gastroenterology reserves the right to bill a patient directly if their insurance company is unresponsive or particularly slow in making payment. Accounts with balances greater than 60 days may be billed to the patient.

Payments may be made by cash, credit, personal checks or money orders. All patients are given one final notice and a grace period to pay or make arrangements to pay the amount due. Delinquent accounts are subject to further collection action including placement with a collection agency. Collection fees, interest or attorney’s fees could be added to the account balance. Carolina Gastroenterology charges a fee for all returned checks. If for any reason you are unable to pay your bill on time, please contact the Billing Office at (919) 854-2500 for assistance.