Insurance & Billing

Fees

Our fees are charged for two primary services:

• Consultation and office visits fees, reflecting the extent or complexity of the condition

 

• Professional fees for performing an endoscopic procedure. This is the doctor’s charge for performing the procedure. Please note that if the procedure is performed at the hospital or Woodburn Endoscopy Center, the they will charge a separate facility fee. You will receive a bill from the anesthesiologist if deep sedation is used for your procedure. In addition, when biopsies are obtained and specimens are sent for tissue analysis, you will receive a separate bill from the pathologists for their services.

Insurance

We participate in most major health insurance plans. As a courtesy, our billing administrator will file your primary insurance claim for fees in the office for consultation, follow-up care, and our professional fees for any procedures performed. Our billing administrator is specially trained to file and follow up on your insurance coverage.

We will assist you in obtaining appropriate pre-certification for procedures that we schedule.

The following plans (except Medicare/Medicaid) require referrals. You will need to call your Primary Care Physician to get your referral faxed or mailed to us prior to or at the time of the visit.

 

1. Optimum Choice / MDIPA:

For your 1st office visit you must have an initial consult form from your referring physician. Also, if you’re an existing patient but have a New Problem you will need a new initial consult form. If you have not been seen in over a year, you will also need an initial consult form. They are usually good for 90 days.

 

2. Care First Blue Choice / Anthem Healthkeepers:

 

It is the patients’ responsibility to call their PCP and get a referral.
They are usually good for 60 days. If the patient does not have one, they possibly could be turned away.

 

3. Aetna HMO:

 

It is the patients’ responsibility to call their PCP and get a referral.
They are usually good for 1 year, but the 1st visit must be within a 90 day period.

 

4. Medicare:

 

We accept assignment on Medicare. We are paid 80% of a Medicare approved amount for your charges. You are expected to pay the remaining 20% of Medicare’s approved amount, either with supplemental insurance or personal payment.

 

5. Medicaid:

 

We accept Medicaid. You must present your eligibility card on the day of your visit. You will be expected to pay your co-payment, if applicable, on the day of your visit.

 

 

Billing

 

What do I have to pay at the time of my visit?

 

We will collect a co-payment at the time of your visit. It is the patient's responsibility to know the amount of their copayment for a "specialist" when the patient arrives for the office visit.

 

What form of payment do you accept?

 

You may pay by cash, check or credit card (Visa or Master Card) for payments greater than $20.

 

What if my insurance does not pay?

 

We will assist you in getting your claim processed. If we are not successful, you will be responsible for the fee.

 

Will you file my secondary insurance?

 

We do file for secondary insurance.

 

Will my insurance pay for a screening colonoscopy?

 

We cannot guarantee that any insurance company will pay; however, most insurance companies cover screening colonoscopy for patients older than 50 years and often for younger patients with a family history of colon cancer. Colonoscopy is also generally covered for patients with specific symptoms such as rectal bleeding and iron deficiency anemia. We provide the information needed to help with processing the claim. If you have concerns about coverage, you should call your insurance company.

 

What if I have other questions about my bill?

 

For billing questions, please call our office at 703-560-3510. If our billing administrator is not available, please feel free to leave a message on her voicemail or with one of our staff. She will return your call within 24 to 48 hours.

 

 

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© 2005 Daniel Ranard and Ben Ranard
The information on this website is not intended to replace the advice of a doctor. If you have medical questions please contact your doctor. If it is a true emergency please call 911 or proceed to the nearest emergency room.

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