To assist our patients, North Shore Gastroenterology has enrolled in numerous managed care insurance programs such as Medical Mutual, Anthem, Aetna, United Health Care and Qual Choice along with many other smaller plans. We are happy to work within the contracted obligations of your plan as long as we know what those obligations are. We encourage our patients to contact their insurance carrier discuss the stipulations of the patient's plan, such as how often a service can be rendered, where the service can be rendered and most importantly if the service is covered under the plan. Below is an outline of our billing policies and procedures.

Commercial Insurance Financial Policy

1. We need for you to understand that your insurance coverage is just that, YOUR coverage. It does not release you from any financial obligations for the services we rendered to you.

2. If you are a new patient, or your insurance coverage changes, you must furnish us with a copy of your insurance card prior to treatment. This card should be given to us within a reasonable time so that we can verify coverage and obtain your benefits.

3. Some insurance policies require a referral from your primary care physician. It is YOUR responsibility to make sure that we have your referral prior to your first visit. Failure to obtain your referral will result in possible cancellations of your appointment.

4. If we are unable to verify your coverage and/or obtain a proper referral, you will be held personally responsible for any balance. Upon receipt of referral and/or verification of coverage, we will then file your insurance.

5. We require our patients to pay 100% of their initial charges and all charges incurred up to the amount necessary to cover their insurance policy's deductible.

6. We require that you pay your co-insurance balance or co-pay at the time of service. A patient's co-pay or co-insurance balance may not exceed $250.00 or your professional care may be terminated.

7. If for any reason your insurance company has not covered your treatment within 120 days, you will be classified as a self-pay patient for outstanding dates of service.

8. Once all insurance payments have been received and it is deemed that you have made an overpayment, we will refund any over payment to you promptly.

Medicare Financial Policy

1. Medicare requires that you pay a $100.00 deductible per calendar year. We must collect any outstanding deductible due on the day that services are rendered.

2. After the deductible is satisfied, Medicare will pay 80% of allowed charges. If you do not have secondary coverage as a supplement, you will be responsible for 20% of those charges on the day the services are rendered.

3. Medicare requires that you sign a waiver called Advanced Beneficiary Notice for each date of service acknowledging that we have explained, to the best of our ability, what is eligible for reimbursement and what is not. This must be signed for every visit.

Self-Pay Financial Policy

1. We require that 100% of the first visit fee be paid at the time care is rendered.

2. If you cannot make a payment when services are rendered, you will be required to meet with the patient case representative to implement a financial payment contract.

3. Payment plans can be arranged with a signed commitment following an appointment with our case representative.

4. Treatment will not be administered to any patient whose balance exceeds $250 without a written and signed financial payment contract.

5. You may request a listing of our fees from our billing department.

Medicaid Financial Policy

1. We are currently accepting Medicaid patients only with direct referral from the patient's primary care physician.

2. You are required to present the current month's Medicaid card at each visit.

For Services Performed in our Endoscopy Facilities

North Shore Endoscopy Center is a separately owned corporation and retains a separate Tax ID number from North Shore Gastroenterology. For billing purposes, you are charged no differently than if your procedure had been performed in a hospital. All patients rendered services in our endoscopy centers will receive 2 billing statements:

1. A charge for your PHYSICIAN'S services

2. A charge for your FACILITY services

Miscellaneous Information

1. We accept cash, debit cards, checks, VISA, Master Card.

2. We require that any amount due be paid at the time of check-in. Please contact our billing office at 216-663-9849 or ask to speak with an on-site billing representative should you have any questions or concerns regarding your bill.

3. The fee for a returned check is $35.00. Checks will no longer be accepted from a patient who has had a returned check.

4. Any patient account balance over 120 days past due, who either does not have a financial payment contract or who is failing to meet the terms of their contract, will be turned over to an outside collections agency.