Insurance and Billing
We Accept Most Insurance Plans
Southwest Gastroenterology and Southwest Endoscopy accept most insurance plans and will bill both primary and secondary insurances as a courtesy. However, the primary responsibility for the account is yours.
Southwest Endoscopy Fees
You can expect to incur up to four charges for different fees associated with your procedure.
Physician professional fee – from Southwest Gastroenterology. This is the charge for the physician who performed your procedure.
Facility fee – from Southwest Endoscopy, an Ambulatory Surgery Center or from the hospital where the procedure is performed; the charge is for the use of the endoscopy facility or hospital and includes the use of endoscopic equipment, supplies, medications, and nursing staff.
Pathology – the charge obtained from the examination of polyps or biopsy specimens.
Anesthesia Fee – from Southwest Gastroenterology if monitored anesthesia care (MAC) is provided. This charge is for the nurse anesthetist who administrates MAC.
Having a procedure at Southwest Endoscopy, an Ambulatory Surgery Center (ASC), offers a lower cost alternative than having a hospital procedure. Southwest Endoscopy is certified by Medicare and accredited by AAAHC. We follow strict guidelines for quality and patient safety and are recognized by the American Society for Gastrointestinal Endoscopy for promoting quality endoscopy. Our state-of-the-art facility and equipment combined with experienced staff focusing on endoscopic procedures offer our patients a very positive care experience. Southwest Endoscopy is owned and operated by the doctors of Southwest Gastroenterology Associates. If you have any further questions, please call our business office at 505-999-1600.
Southwest Gastroenterology and Southwest Endoscopy require a credit card on file for all patients. Southwest Gastroenterology will access a fee of $25.00 for all no-show appointments and appointments canceled with less than 24 hours' notice. Southwest Endoscopy will access a fee of $50.00 for all no-show appointments and procedures canceled with less than three business days' notice. There will be a $35.00 returned item fee for all returned checks.
Listed below are the fees associated with the procedures at Southwest Endoscopy. While we cannot guarantee your procedure's exact dollar amount, we hope this will serve as a guideline when contacting your insurance company to determine your benefits. The final cost of your visit cannot be determined until the physician has fully examined you and completed the procedure. It is not uncommon to have biopsies done and/or polyps removed at the time of the procedure. Most patients who have a biopsy taken or a polyp removed have two or three specimens examined by a pathologist. In such cases, you will receive separate bills from the pathologist. Your insurance company will determine the actual allowed amount for each charge.
Insurance coverage for these procedures varies amongst insurers. It is important to check your individual policy and direct any questions to your insurer to determine coverage and your financial responsibility prior to receiving treatment.
UPPER ENDOSCOPY (EGD)
Upper Endoscopy procedures are generally covered by insurance when recommended to investigate symptoms (they are never covered as screenings).
Be advised that insurance coverage for colonoscopy procedures is less predictable. Several variables affect how these claims are required to be coded. Below is a snapshot of the most common scenarios. If you are scheduled for a colonoscopy, Southwest Gastroenterology recommends that you call your insurance provider and ask how your particular plan pays for these procedures. We cannot change the coding to accommodate the highest benefit level of your plan requesting us to do that is asking us to file a false claim.
Screening Colonoscopy – a colonoscopy for a patient aged 50 and over, with NO GI signs or symptoms, NO high-risk factors (to include personal/family history of polyps and/or colon cancer), and NO abnormal findings are found at the time of the procedure.
Colonoscopy types that may fall under the medical benefit of a patient’s plan
Screening Colonoscopy (that turns diagnostic) – a colonoscopy for a patient aged 50 and over, with NO GI signs or symptoms, NO high-risk factors (to include personal/family history of polyps and/or colon cancer), and abnormal findings are found at the time of the procedure (polypectomy/biopsy performed). Unfortunately, this situation can’t be predicted ahead of time. If polyps are removed, any future colonoscopy procedures will be considered “surveillance” since the patient now has personal history.
Surveillance Colonoscopy (high-risk) – a colonoscopy for a patient aged 18 and over, WITH high- risk factors (to include personal/family history of polyps and/or colon cancer), regardless of findings (normal or abnormal).
Diagnostic Colonoscopy - a colonoscopy for a patient aged 18 and over, WITH GI signs or symptoms, regardless of findings (normal or abnormal).
Medicare patients – Medicare pays for colonoscopy screenings at 100% IF no polyps are removed (even if there is family or personal history). However, if polyps are found or biopsies are taken, Medicare will process the claim as “medical” and is subject to the Medicare coinsurance.
Remember, even though you are being “screened,” it doesn’t necessarily mean that your screening type will fall under the Preventive criteria of your particular insurance plan.
Out of Pocket
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 outpatient endoscopic procedures. Deductibles can be annual or per procedure. Co-payments for outpatient endoscopic 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.
If you are scheduling a procedure that is not covered by insurance, then, subject to any available discounts, you will be responsible for 100% of the charges for your service. The average charge for hospitals can be significantly higher than the average charges of an independently-owned ASC (Ambulatory Surgery Center). Southwest Endoscopy offers a 30% discount to self-pay, uninsured patients who elect to pay in full. We also offer a flat fee payment plan with a 50% prepayment due on the day of your procedure. To schedule an appointment, call our office at (505) 999-1600.
No Show fees
Out of consideration for other patients and staff, Southwest Gastroenterology and Southwest Endoscopy ask that all procedure cancellations be made with at least 72 hours' notice, in addition, we ask that office visit cancellations be made with at least 24 hours' notice. Failure to give adequate notice of cancellation may lead to a fee of $100.00 for procedures and $50.00 for office visits
Southwest Gastroenterology and Southwest Endoscopy use Transworld collections agency for all collections purposes and they can be reached at 1-888-446-4733.
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, health care providers need to give patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least one (1) business day before your medical service or item. You can also ask your health care provider and any other provider you choose for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.