Understanding Your Healthcare Costs
Healthcare expenses can be significant, and it’s important to be informed about your insurance benefits. Please contact your insurance company directly if you have any questions regarding covered services or the portion of the bill you may be responsible for, such as deductibles or copayments.
Keep in mind that some services may not be covered or might not be deemed medically necessary by your insurance provider. For services that are not covered or not authorized, we require payment in full prior to your appointment.
Bring your insurance card
We work with most insurance plans. Your insurance ID card provides the essential information needed for us to submit claims and obtain payment for services. You are required to present insurance card(s) at each visit so we can verify your coverage.
If we do not have current and accurate insurance information, you will be responsible for the bill.
Co-payments Policy
All co-payments are required to be paid at the time of service, as stipulated in your contract with your insurance company. It’s important to note that failure to collect co-payments can be considered fraud.
If you are unable to pay your co-payment at the time of your appointment, we may need to reschedule your visit.
Updating Your Insurance Information
If your insurance changes, please notify us before your next visit so we can update our records and help you receive your maximum benefits. Many insurance companies require authorizations prior to appointments. Without accurate information, we may be unable to obtain the necessary authorization, and you could be responsible for the charges.
Claims Submission
We will submit claims to your insurance company and work diligently to get your claims paid. Your insurance company may require further information from you, and it is your responsibility to comply with their request. Your insurance benefit is a contract between you and your insurance company. Please be aware that the balance of your claim is your responsibility if your insurance company does not pay your claim.
Private Pay Policy
Payment for the estimated cost of your service is due prior to your appointment. A representative from our Central Billing Office will contact you to provide a good faith estimate (GFE) and discuss payment options.
You will be billed for any charges beyond the estimated cost or refunded if the actual charges are lower than the estimate.
No Surprises Act
Beginning January 1, 2022, CMS enacted a law to protect both the insured and uninsured from surprise medical bills. Learn more about your consumer rights to dispute unexpected bills.
Balances due and Collections
You will receive periodic statements regarding any outstanding balances. We encourage you to use our patient portal for easy online payments, but you may also pay over the phone or by mailing a check.
If your account is overdue by more than 90 days, you will be notified that you need to pay the balance within 30 days. Failure to do so may result in your account being referred to a collection agency. Please note that you must settle your account with us or the collection agency before scheduling any future appointments.
Payment Authorization
You will be asked to sign Portland Gastroenterology Center’s billing policy and a payment authorization at the time of your visit.
Understanding Procedure Billing
Every procedure that is performed includes up to 5 components. Each of these components bill for their services separately. You may not have all 5 components depending on your situation, but you will always have at least 2.
A physician fee and a facility fee are always charged regardless of where the procedure is done.
Below is an example of a colonoscopy performed at Portland Endoscopy Center where a biopsy is taken, and the patient opted for Propofol anesthesia. This patient will receive 5 separate bills.
