Insurance
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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2003 Gastroenterology of Southern Indiana, P.C.
Southern Indiana Endoscopy, LLC
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