You are scheduled to have an endoscopic procedure at Eastside Endoscopy Center. The procedure will be performed by one of the GI Medicine physicians. During the procedure you will receive sedation administered by one of the Eastside Group LLC anesthesiologists/CRNA’s (Certified Registered Nurse Anesthesiologist).
Frequently during the endoscopy your doctor will take a biopsy(s). If a biopsy is obtained, the specimen will be processed at either at the GI Medicine Histology Lab or St. John Hospital and will be interpreted by one of the pathologists from Pathology Specialists of Southeast Michigan.
Your procedure will generate the following different charges to your insurance or to you, if you do not have insurance:
How to read your insurance statement:
Your insurance statement, (EOB), sometimes can be confusing. The following information may help you to understand this document:
Issues related with screening colonoscopy:
What is a screening colonoscopy? A screening colonoscopy is a colonoscopy that is performed in order to find out if the patient has colon polyps or cancer. It is not a colonoscopy that is performed to explain the patient’s symptoms (i.e. blood in stools, changes in bowel movements, etc.).
Medicare will cover screening colonoscopies. Medicare will not apply the deductible to screening colonoscopies but will apply the co-payment.
Most of the private insurances will cover screening colonoscopies, but there are a few insurances and contracts that will not cover screening procedures like colonoscopies.
If a Medicare patient is scheduled for a “screening colonoscopy” and during procedure a polyp is found or the physician needs to take a biopsy, this procedure is no longer considered screening. Medicare requires that we now bill as a non-screening (diagnostic) colonoscopy. In this situation, the patient now becomes responsible for the deductible if it has not been met.
We are legally obligated when we bill Medicare and private insurance carriers, to follow their billing policies based on the medical information available to us. Not following Medicare rules will be considered fraud and will expose us to significant penalties.
Please call the numbers listed above if you have any questions regarding your bill – we will be happy to help you.