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Why am I receiving multiple bills for the services?

When a procedure such as a colonoscopy is performed, there is always a minimum of two billings incurred. One is for the physician fees, which you receive from a Gastro Health Care Center, and the other is for the facility fees such as a hospital or the endoscopy center. You may also receive a bill for anesthesia services, the reading of your pathology samples, and other lab tests if those services were provided.

Loudoun Gastro + bill from facility + anesthesia + Pathology = Total Cost

What is a deductible, allowed amount, and coinsurance?

A deductible is the cost of expenses that you must pay out of pocket before your insurance will pick up the bill. An allowed amount is when you must pay towards your deductible before your insurance pays for your bill. This amount is a contracted rate between your insurance and our providers, and we cannot tell you the cost of your visit until the patient is seen by the doctor. Coinsurance is a percentage of your bill that you must pay while your insurance covers the rest. Typically, the deductible must be met before you have a coinsurance.

Do you offer payment plans or discounts?

The bill you are receiving is for the amount of the contracted rate between your insurance company and the doctor. We are not allowed to offer any discounts per our contract with your insurance. If you are a self-pay patient, your rate has already been discounted. We do offer payment plans. Please contact us to set one up.

Screening Colonoscopy vs. Diagnostic Colonoscopy

If you are here today because you were sent to one of our providers for a “Screening Colonoscopy” or you have seen the physician and he/she recommends a colonoscopy, please read this in its entirety. You need to be fully educated on the state and federal guidelines for reimbursement services.

The CMS “Screening Initiatives” passed in January 2011, dictates that patients undergoing a screening colonoscopy will not be held to their coinsurance or deductible responsibilities.

The definition of a “screening colonoscopy” per CMS guidelines is as follows: “A colonoscopy being performed on a patient who does not have any signs of symptoms in the lower GI anatomy PRIOR to the scheduled test.”

Any symptom, such as change in bowel habits, diarrhea, constipation, bleeding, anemia, etc., prior to the procedure and noted as a symptom by the physician in your medical record may change the benefit from a Screening to a Diagnostic Colonoscopy. We cannot change your medical record after you have been seen, nor can we change the fact you have had symptoms prior to your procedure.

Please note: If you had a colonoscopy within the last 10 years and the result indicated you had colon polyps, you may NOT be eligible for “screening initiative” benefits. Because if you have a prior history of polyps, your colonoscopy is now considered a “surveillance of the colon” and therefore may be considered diagnostic. You may have been healthy and had no symptoms since your last colonoscopy, but you have what is considered a pre-existing nature of polyps, and therefore, are not eligible to be classified as “screening.” However, if your last colonoscopy was 10 years ago or more, then you are eligible for a “screening colonoscopy,” regardless of history. It is your responsibility to know your insurance benefits. Please contact your insurance company with benefit questions prior to your procedure.

Please be advised that if you are a true “screening colonoscopy” and during the procedure your doctor finds a polyp or tissue that must be removed for pathological testing or if you are diagnosed with a GI problem, the procedure is no longer a “screening” and becomes “diagnostic.” Please be aware that any polyp that is found may be pre-cancerous and must be removed. Your insurance benefits may change. We make every effort to code correctly for your procedure with the correct modifiers and diagnoses. We make every effort to work with the facility to have the billing coded correctly as well. The correct coding of a procedure is driven by the physician and your medical history. It is not dictated by your benefit or the insurance company.

*Please note that these guidelines are not necessarily in line with our Providers’ belief for proper patient care, however they are upheld as required by CMS Policies and Procedures.

Understanding Your Pathology Report: Colon Polyps (Sessile or Traditional Serrated Adenomas)

When your colon was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. The pathologist sends your doctor a report that gives a diagnosis for each sample taken. This report helps manage your care. The questions and answers that follow are meant to help you understand the medical language used in the pathology report you received for your biopsy.

What if my report mentions the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, or rectum?

These are all parts of the large intestine. The cecum is the beginning of the colon, where the small intestine empties into the large intestine. The ascending colon, transverse colon, descending colon, and sigmoid colon are other parts of the colon after the cecum. The colon ends at the rectum, where waste is stored until it exits through the anus.

What is a polyp in the colon?

A polyp is a projection (growth) of tissue from the inner lining of the colon into the lumen (hollow center) of the colon. Different types of polyps look different under the microscope. Polyps are benign (non-cancerous) growths, but cancer can start in some types of polyps. These polyps can be thought of as pre-cancers, which is why it is important to have them removed.

What is an adenoma (adenomatous polyp)?

An adenoma is a polyp made up of tissue that looks much like the normal lining of your colon, although it is different in several important ways when it is looked at under the microscope. In some cases, a cancer can start in the adenoma.What are tubular adenomas, tubulovillous adenomas, and villous adenomas?

Adenomas can have several different growth patterns that can be seen under the microscope by the pathologist. There are 2 major growth patterns: tubular and villous. Many adenomas have a mixture of both growth patterns, and are called tubulovillous adenomas. Most adenomas that are small (less than ½ inch) have a tubular growth pattern. Larger adenomas may have a villous growth pattern. Larger adenomas more often have cancers developing in them. Adenomas with a villous growth pattern are also more likely to have cancers develop in them.

The most important thing is that your polyp has been completely removed and does not show cancer. The growth pattern is only important because it helps determine when you will need your next colonoscopy to make sure you don’t develop colon cancer in the future.

What if my report uses the term sessile?

Polyps that tend to grow as slightly flattened; broad-based polyps are referred to as sessile.

What if my report uses the term serrated?

Serrated polyps (serrated adenomas) have a saw-tooth appearance under the microscope. There are 2 types, which look a little different under the microscope:

  1. Sessile serrated adenomas (also called sessile serrated polyps)
  2. Traditional serrated adenomas

Both types need to be removed from your colon.

What does it mean if I have an adenoma (adenomatous polyp), such as a sessile serrated adenoma or traditional serrated adenoma?

These types of polyps are not cancer, but they are pre-cancerous (meaning that they can turn into cancers). Someone who has had one of these types of polyps has an increased risk of later developing cancer of the colon. Most patients with these polyps, however, never develop colon cancer.

What if my report mentions dysplasia?

Dysplasia is a term that describes how much your polyp looks like cancer under the microscope:

  1. Polyps that are only mildly abnormal (don’t look much like cancer) are said to have low-grade (mild or moderate) dysplasia.
  2. Polyps that are more abnormal and look more like cancer are said to have high-grade (severe) dysplasia.

The most important thing is that your polyp has been completely removed and does not show cancer. If high-grade dysplasia is found in your polyp, it might mean you need to have a repeat (follow-up) colonoscopy sooner than if high-grade dysplasia wasn’t found, but otherwise you do not need to worry about dysplasia in your polyp.

How does having an adenoma affect my future follow-up care?

Since you had an adenoma, you will need to have another colonoscopy to make sure that you don’t develop any more adenomas. When your next colonoscopy should be scheduled depends on a number of things, like how many adenomas were found, if any were villous, and if any had high-grade dysplasia. The timing of your next colonoscopy should be discussed with your treating doctor who knows the details of your specific case.

What if my adenoma was not completely removed?

If your adenoma was biopsied but not completely removed, you will need to talk to your doctor about what other treatment you’ll need. Most of the time, adenomas are removed during a colonoscopy. Sometimes, though, the adenoma may be too large to remove during colonoscopy. In such cases you may need surgery to have the adenoma removed.

What if my report also mentions hyperplastic polyps?

Hyperplastic polyps are typically benign (they aren’t pre-cancers or cancers) and are not a cause for concern.