Common Questions
How do I know if I need a referral for my office appointment or procedure?
Many insurance plans require a referral, including HMO’s, from your primary care doctor to visit a specialist. Your insurance company will be able to tell you if you need a referral, but ultimately it is your responsibility to know if a referral or written authorization is required before each visit and to obtain one. You can call your insurance company or our billing department if you have any questions. We will refer to your current insurance and inform you if a referral is required.
What are my financial responsibilities for my upcoming procedure?
Depending on your insurance benefits, you may have a deductible that is due on the day of your office visit or procedure. If you have an unmet deductible or co-pay, you will receive a call from our billing team notifying you of this information. Any payments are due the day of the procedure. You can also contact your insurance company for more information. You may receive a call from our billing specialists to inform you if any payments are due on the day of your procedure. Please return this call at 630-527-6450 option 5, if you are unable to answer.
Is there a co-pay for my visit?
You may have a co-pay for your visit. If you do, office visit co-pays are due at time of service. Please bring your insurance card to every visit. Please also notify our office as soon as possible if you’re insurance has changed. You can also contact your insurance company if you are not sure of the benefits.
What is the difference between screening and diagnostic?
A screening colonoscopy is for patients who are 45 years or older, have not had a colonoscopy in the past 10 years, have no personal history of colon polyps, gastrointestinal disease, and/or cancer and have no present gastrointestinal symptoms. Coverage can vary based on your current insurance policy guidelines. After the first colonoscopy is performed, any future colonoscopies could be considered diagnostic depending on results of your previous colonoscopy. A diagnostic colonoscopy is for patients who are currently have a personal history of colon polyps, showing symptoms or have a personal history of gastrointestinal disorders. Please call our billing department if you have any questions at 630-527-6450, option 5.
Is a precertification required before my procedure?
A precertification is required for most health insurance companies. Our office will obtain the precertification before your procedure. You may also contact your insurance company to confirm your benefits and to see if any such authorization is required.
Where will I receive bills from?
You may receive separate bills from the following companies:
Midwest Endoscopy
- Facility service charge
Suburban Gastroenterology
- Physician professional charge
- Pathology
Mobile/Lindenhurst Anesthesia
- Anesthesia
- Please call 855-457-9900 if you have any billing questions for Mobile Anesthesia.
Edward Hospital Lab and Pathology Diagnostics LLC
- Pathology (if not performed at Suburban GI)
Cancelation Policy
At Suburban Gastroenterology, Ltd., we put our faith in you to keep your appointment. Many offices double book appointments to prevent from being financially damaged as a result of a missed appointment. We choose not to do this. We prefer to provide excellent care and individualized attention to each patient we care for, allotting designated time for each patient.
If for any reason you must cancel or change your Suburban Gastroenterology office appointment, it is important that you give our office at least two business days’ notice prior to your scheduled appointment date to allow us to offer the appointment to another patient. If you fail to do this, there will be a $50.00 cancellation fee applied.
If for any reason you must cancel or change your Midwest Endoscopy Center procedure appointment, it is important that you give our office at least five business days’ notice prior to your scheduled procedure date to allow us to offer the appointment to another patient. If you fail to do this, there will be a $150.00 cancellation fee applied.
We understand that true emergencies do occur. Under these circumstances a doctor’s note or other appropriate documentation will be considered to have the charge waived.
Common billing terms and definitions
- Pre-authorization: A pre-authorization, sometimes called a precertification, is a process by which health care providers must obtain advance approval from a health insurance company before a specific service will be covered by insurance. It’s a simple way to ensure your insurance will cover what you need.
- Co-pay: A copay is a set fee you pay for a doctor visit. Your copay is due on the date of service.
- Co-insurance: Co-insurance is the percentage of costs for a covered health care service that you’re responsible for paying after you have met your deductible. For example, if you’re insurance plan has a co-insurance of 20%, it means you will pay 20% of the cost and your insurance will pay the remaining 80%. This is after you have met your deductible.
- Referral: An order from your primary care doctor for you to see a specialist or get certain medical services completed. HMO’s require a referral before you can get medical care from anyone except your PCP.
If you have any questions, please contact our billing department at 630-527-6450, option 5.
