Financial Info

The financial aspects of medical care are often confusing and poorly understood. This is in part due to a “hidden mystique” about medical costs and billing practices by physicians, allied health providers, hospitals, and insurance companies. The introduction of the Affordable Care Act (“Obamacare”) adds another level of complexity and uncertainty about health care and its costs for the future.

Many wonder why medical care is so costly. This is a complex matter with many contributing factors and cannot be completely addressed here. We have found and to be examples of helpful resources regarding healthcare and its costs.

Some of the factors contributing to the cost of physician charges include the increasing dependence on computer technology, the increasing burden of government and insurance regulations, and the increasing cost of medical liability insurance. All of these require additional staff and consultants to run the business aspect of medicine.

Our Charges

It is our desire to be honest, transparent, and clear regarding your health care costs. Our charges are as follows.

* Charge is determined by detail of history and examination, medical complexity, and/or time spent with the patient. ** Charge is determined by the complexity of the procedure performed such as biopsy, polypectomy, treatment of bleeding, etc.

Insurance Info

Due to the cost of procedures, please make sure you will have coverage for your colonoscopy and/or EGD before you schedule. Your insurance can give you an idea of what your out of pocket cost will be. Your cost for these services will depend upon how your individual insurance works. If you have questions about your insurance coverage, please contact your insurance carrier.

A Few Common Costs

Many insurance companies require a co-pay for each office visit. These co-pays vary in amount and you are expected to pay them at the time of your visit. Most plans have some sort of deductible. These deductible amounts vary from plan to plan and you are responsible for paying up to this amount for your bills, before your insurance starts paying. Many plans also have some sort of co-insurance or cost sharing plan that comes into effect after you have met your deductible. For example: with an “80/20” plan, the insurance company will pay 80% of your bill and you are responsible for 20%.

Insurance We Accept

We accept most insurance plans (see below), but it is best to call your insurance and ask if we participate in your specific plan. As a convenience, we will submit a claim to your insurance company on your behalf. After we receive payment from your insurance, you will receive a statement from us. In that statement, you will see our charge, the amount paid by your insurance, and the balance due for which you are responsible. We will make every effort to help you understand your bill and resolve any dispute if you have questions. Please also be aware that if you have an endoscopic procedure you will also receive a bill from the facility where your procedure is performed. If you have anesthesia administered by an anesthesiologist or nurse anesthetist you will also receive a bill for their services. If any biopsies are taken or polyps are removed, you will receive a bill from the pathologist.

If You’re Uninsured...

Frequently Asked Questions

What is a screening colonoscopy?

A screening colonoscopy is a colonoscopy performed in patients who have no symptoms. The purpose is to identify and remove precancerous polyps or to identify a cancer in the pre-symptomatic stage when it is more likely to be cured.

What is a surveillance colonoscopy?

A surveillance colonoscopy is a colonoscopy performed for follow up of a cancer or a precancerous polyp or condition (such as chronic colitis). It is performed at shorter intervals than screening colonoscopy.

What is a diagnostic colonoscopy?

A diagnostic colonoscopy is a colonoscopy performed for evaluation of symptoms.

What is a surgical or therapeutic colonoscopy?

A surgical or therapeutic colonoscopy is a colonoscopy in which a biopsy is obtained, a polyp is removed, or some other type of therapeutic procedure is performed.

Because certain insurance companies cover these varying colonoscopies in different ways it is best to check with your insurance company to see how they handle coverage for colonoscopy and what your out of pocket expense may be. Many insurance companies will fully cover the cost of a screening colonoscopy. However, if a polyp is found and removed during a screening colonoscopy, some insurance companies will redefine the screening colonoscopy as a surgical colonoscopy and will no longer fully cover the procedure. Also, it is important to recognize that once a precancerous polyp or cancer has been found, all subsequent colonoscopies become, by definition, surveillance colonoscopies. Many insurance companies will no longer cover these colonoscopies as a fully covered preventative benefit.

Medicare Patients

Medicare will only pay for a screening colonoscopy every 10 years (or at least 119 months since the last screening colonoscopy) unless you are considered to be high risk for cancer. If our practice has no records of your last screening colonoscopy, and you cannot provide documentation of when your last colonoscopy was, you will be required to sign an Advance Beneficiary Notice (ABN) with our office. An ABN is given when the service or procedure may or may not be covered. Please call Medicare to verify if you’re eligible for coverage of your screening colonoscopy.

Financial Disclosure

Dr. Zachary is a stockholder in Manhattan Surgical Center and receives a dividend from profits made by that facility. See Disclosure of Ownership

Insurance plans our office participates with (In-Network Providers)

If you don’t see your Insurance listed, please call the number on the back of your insurance card and ask them if Manhattan Gastroenterology is a participating provider with your specific plan.