Billing
Screening VS Diagnostic Colonoscopy
The Affordable Care Act requires that recommended preventative services such as colonoscopies be covered at no cost to the patient. However, strict guidelines are used by insurance companies to determine whether a colonoscopy is categorized as preventative or diagnostic.
Preventative Colonoscopy Screening: Patient is asymptomatic (no present gastrointestinal symptoms), is age 45 or older, and has no personal history of gastrointestinal disease, colon polyps and/or cancer.
Surveillance / High-Risk Colonoscopy: Patient is asymptomatic (no present gastrointestinal symptoms) and has a personal history of gastrointestinal disease (such as diverticulitis, Crohn’s disease or ulcerative colitis), colon polyps and/or cancer. Shorter intervals between colonoscopies are recommended for these patients (usually every 2 – 5 years). Some insurance carriers consider surveillance / high-risk colonoscopies to be preventative, while others consider them to be diagnostic.
Diagnostic / Therapeutic Colonoscopy: A colonoscopy is performed to evaluate or treat gastrointestinal symptoms, colon polyps or gastrointestinal disease.
Copay VS Deductible
A copay is a set dollar amount outlined by your insurance policy that you pay for your service. Usually this does not count towards your deductible.
A deductible is the amount you pay out of pocket before your insurance covers the remaining cost.
Please be prepared to pay your copay at the time of your visit. If you are unsure of what the dollar amount is, reach out to your insurance carrier for assistance.
Understanding Your Bill - Facility Fee
Commonwealth Gastroenterology does not bill for anesthesia or facility fees.
You may receive separate bills for each of these services after your procedure.
If you have questions regarding these charges please reach out to the facility you are/were scheduled at and ask for the billing department.
Most Major Insurances Accepted
Out of Network: Cigna Connect, Carelon/Caremore