We accept many insurance carriers and will work with you on your claims.
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Insurance coverage Medicare Managed Care Plans
Insurance Coverage
If your insurance covers office visits, we will be happy to file your claim for you.  Should your condition require any type of procedure, we will be glad to file a claim for that as well.  We use a standard claim form approved by the Health Care Financing Administration (HCFA).  Because there are so many different insurance companies with many different regulations, it is imperative that you present your insurance cards at the time of your first visit.

We participate with most insurance plans with the exception of the following*:

At Gastroenterology of Southern Indiana:

  • Aetna
  • Kentucky Medicaid

At Southern Indiana Endoscopy:

  • Cigna
  • Humana
  • Aetna
  • Sagamore
  • Kentucky Medicaid

We see many patients covered by other health plans on an "out of network" basis.  Health plan contracting changes frequently, and our staff are pleased to answer your questions concerning our participation status with your health plan. 

We actively participate with most private insurance carriers.  If you question our participation with a carrier, please contact that carrier directly for information.  Many of these policies require a referral from your primary care provider (PCP) and/or prior authorization certification.  If prior authorization is not obtained where necessary, the result is often times a decrease in benefit or no payment whatsoever.  For these reasons, it is very important that you show us your insurance cards.  As noted above, we will be happy to file your claim for you.

Medicare
Your doctor voluntarily participates in the Medicare Assignment Program.  This means that we will submit your Medicare claims for you along with any secondary or supplemental coverage you may carry.  Medicare will approve a "UCR" (usual, customary and reasonable) fee, and pay 80% of the approved amount.  True supplemental insurance will pay the 20% difference between the approved and payable amounts.

Your responsibility will only be the amount between what Medicare approves and actually pays, plus any remaining deductible.

Managed Care Plans (MCP)
If you have been referred to us, your MCP will often require a written referral from your primary care provider (PCP).  This is extremely important; non-compliance with your insurance company's rules may result in reduced payments to you and/or your physician.  Please familiarize yourself with the specific guidelines set by your carrier.  This is another reason it is so important that you present your insurance card to us at the time of your visit.

Again, experienced insurance reimbursement specialists are available to assist you with any questions you may have.

 

*Patients should always check with their insurance carriers prior to making appointments to verify specific coverages.

 

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