We participate with most insurance companies for patients age 16 and up. Our office staff makes every effort to be well informed regarding insurance; however, it is your responsibility to be familiar with your particular policy. Please check prior to your appointment if your physician is in your network or if you have any pre-existing conditions on your policy (see below). If your insurance requires an insurance referral from your primary care physician, it is your responsibility to obtain that referral. If you do not provide us with a referral, you are assuming responsibility for payment of that visit. If you do not have insurance, please contact our office prior to your appointment for payment options.
Copays are due at time of service. We accept cash, checks, Visa, Master Card, Discover and American Express. You will receive a bill for the balance due after an insurance payment, which will be due upon receipt. If your account goes to a collection agency, you will be responsible for all costs of collections.
What is a pre-existing condition exclusion period?
A pre-existing condition exclusion period is a period of time during which your insurer is not obligated to pay claims related to your pre-existing condition. A pre-existing condition is a medication condition for which medical advice, diagnosis, care or treatment was recommended or received within the 6-month period before your enrollment date in an employer’s group plan.
Our office checks to see if prior authorization is required for outpatient procedures and x-rays. Please check your benefits prior to having a colonoscopy, endoscopy or any testing done. Your insurance benefits may vary (some insurance policies only cover if done in an office setting). Ask what your benefits are for a procedure performed in a physician office versus an outpatient hospital setting or ambulatory surgical center. All of our procedures, x-rays and laboratory studies are done at Halifax Regional Hospital on an outpatient basis. Ask if Halifax Regional Hospital is in your network.
If you are having a colonoscopy, know what type of colonoscopy you are having. A screening colonoscopy is performed for screening only and there is no medical diagnosis. A diagnostic colonoscopy is performed for a medical problem or diagnosis. Ask what your benefits are for a screening colonoscopy versus a diagnostic colonoscopy. Even if you are scheduled for a screening colonoscopy, if your doctor removes a polyp or takes a biopsy, some insurance companies will no longer recognize this as a screening colonoscopy.
Please be aware when your doctor performs a procedure, you may receive bills from multiple providers. There will be professional fees (doctor charges), facility charges (hospital fees), and possible anesthesia and pathology charges.
We participate in the following insurance:
MEDICARE
ANTHEM
PRIMARY PHYSICIAN CARE
SOUTHERN HEALTH
MEDICAID IN VA – OPTIMA, HEALTHKEEPERS PLUS, VA PREMIERE { not out-of-state Medicaid }
UNITED HEALTHCARE
CIGNA
VA HEALTH NETWORK
JP FARLEY
MULTIPLAN
INSURANCE DESIGN ADMINISTRATORS
MEDCOST { pending }
We advice patients to check with their individual plan. We do not participate with Anthem Healthkeepers or HMO plans.