Southwest Gastroenterology Associates

Understanding fees, insurance coverage and out of pocket expenses for your procedure

Fees

 

You may receive up to three statements for different fees associated with your procedure.

            1.         “Professional fee” from Southwest Gastroenterology (business office 505-999-1630). This is the charge from the physician who performed your procedure.

            2.         “Facility fee” from the endoscopy center, Southwest Endoscopy, which is owned by the doctors of Southwest Gastroenterology (business office number 505-999-1635).  Procedures are also performed at Lovelace (505-727-8000) or Presbyterian (505-841-1234).  This charge is for the use of the endoscopy facility or hospital and includes the use of endoscopic equipment, medications, and nursing staff.

            3.         “Laboratory fees”. This fee applies only when biopsies are taken or polyps are removed.  This is a bill from pathology services at SED Labs, Tri-Core Labs, or Petroglyph Pathology.

 

Insurance Coverage

 

Endoscopy procedures are generally “covered” by insurance when recommended to investigate symptoms.  Insurance coverage for colon cancer screening is less predictable.

If you are scheduled for a colonoscopy for colon cancer screening, Southwest Gastroenterology recommends that you call your insurance company and ask the following questions, “Is colonoscopy for colon cancer screening (CPT code 45378, ICD-9 code V76.51) a covered benefit?”  Make a note of the representative’s name and the date and time that you called for your records.  If you are told that a procedure is not covered, call your physician to discuss your options including self-payments and alternative procedures. 

Please remember, it is your responsibility to ensure that insurance “covers” a procedure done for screening.  Southwest Gastroenterology is not responsible if the insurance claim is denied.

Click Here for a List of Participating Insurance Plans

 

Out of pocket expenses 

 

A patient’s share of the cost of a procedure, the “out of pocket expense”, is defined by the patient’s insurance policy.  Out of pocket expenses include deductibles and co-payments for ambulatory surgery.   Deductibles can be annual or per procedure.  Co-payments for ambulatory surgery are usually higher than for office visits.  Almost all plans, including HMOs and PPOs, have deductibles and co-payments for ambulatory surgery.  Call your insurance provider to determine your deductible, how much of that deductible remains, and the co-payment for ambulatory surgery. 

 

For any endoscopic procedure, the patient’s insurance company determines the deductible and co-payment amounts.  The patient is financially responsible for these amounts.

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Accreditation

Southwest Endoscopy is accredited by the Accreditation Association for Ambulatory Health Care, Inc. and is Medicare Certified. Southwest Endoscopy is owned and operated by Southwest Gastroenterology.