Office Billing Policy

Complete and accurate insurance billing information, including presentation of my insurance card, to the Center for Gastrointestinal Medicine of Fairfield & Westchester, P.C. must be given at time of visit.

Patient is responsible for co-payment, payable at the time of visit and any deductible or percentage of the billed service considered the patients responsibility by the insurance company after payment of that service has been issued to physician.

It is patients responsibility obtain a referral from primary care physician if required, prior to scheduled appointment.  The office will not make calls on patients behalf to check on the status of referral if it is not in place at the time of office visit.

Failure to present the correct billing information at the time of service may result in a denial of benefits from the insurance carrier.  In this event, patient will be billed for services rendered and will be responsible for the balance.

We will obtain pre-certification; however this does not guarantee coverage for colon cancer screening procedures.  Most insurance companies do not require pre-certification for colonoscopy, however, they may not pay for your procedure unless you have a risk factor, diagnosis or if you meet a particular companies age requirement for colonoscopy. It is your responsibility to research the terms of your coverage as it applies to your upcoming procedure

Patient will be billed for these appointment types with less than 24 hours cancellation notification to the office as follows:

$ 50.00 fee for missed appointments, no shows, or late arrivals (patient will not be seen) which make it impossible for the physician to maintain his or her appointment schedule.

$ 200.00 fee for missed procedure appointments without a minimum of 24-hour notification.

Additional prior authorization services, provided in the attached document, will result in $25.00 administrative fee.

If referred to a specialist, laboratory and / or radiology facility, patient is responsible for verifying that the physician, lab or radiology facility referred to is a current participating provider with their insurance network. If a bill is received from such a facility, the patient will contact the facility directly to provide them with my information and/or insurance referral.

See attached form to be printed out and given to physicians office at time of visit.

Download form here.