Financial Information
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Self pay, co-payment, deductible and co-insurance payments are expected at time of service. The amount owed is based on the information provided to us by you and your insurance company at the time of verification. We allow sixty (60) days for payment of these services. If you anticipate payment problems, please contact our Billing Department at (864) 451-5095. If your plan reimburses you directly, your paid office encounter bill may be used as a claim form.
- Hospital And/Or Outpatient Procedures
We file insurance claims for professional services provided at the hospitals, Greenville Endoscopy Centers and Clemson Endoscopy Center.
- Please call your insurance company to verify coverage for preventative, routine or screening services, and also confirm your scheduled facility is in network.
We may contact you with an estimate of your financial responsibility prior to your procedure based on our insurance verification. Depending on your coverage, you may receive the following bills once insurance has processed:
Physician Fee
Fee paid to physician for performing services. This statement will be from Gastroenterology Associates.
Anesthesia Fee
If your procedure is in Greenville Endoscopy Center, the statement will be from Gastroenterology Associates. If your procedure is in any other facility, that facility will send you a statement.
Pathology Fee
You can expect a separate bill from the laboratory or pathologist if you had a biopsy or a polyp removed. Greenville Endoscopy Center sends its pathology specimens to Pathology Consultants or Upstate Pathology.
Facility Fee
The facility in which you have the procedure performed will send you a separate bill. We suggest contacting your insurance to ensure your scheduled facility is in network. Some insurance plans have facility copayments that range from $200-$400.
Facilities used by our providers:
- Greenville/Clemson Endoscopy Center (billing services provided by Gastroenterology Associates)
- Spartanburg Regional Hospital System
- Prisma Hospital System
- Please determine prior to your visit if your insurance company requires pre-certification for your visit, hospital admission or procedure. Your insurance company may not pay for services if the service is not pre-certified. We do not guarantee your insurance benefits. Routine or preventative services may be non-covered services. You are responsible for the bill once service is rendered. Communicate with us to ensure payment by your insurance company.
Our offices accept Visa, Mastercard, Discover, American Express, Cash, Check, Health Savings Accounts, and Flexible Spending Accounts. You may pay in our offices, by phone or pay on our patient portal. We allow sixty (60) days for payment for these services. If you anticipate payment problems, please contact our Billing Department at (864) 451-5095.
- Insurance Coverage
Gastroenterology Associates is a participating provider with Medicare and several managed care insurance plans.
We will submit primary, secondary, and tertiary claims on your behalf as long as the needed information is provided before your visit. As the patient, it is important to understand your health care coverage prior to scheduling an appointment.
- Please check with your insurance carrier to confirm the following:
- provider and facility are in-network
- know your annual deductible and out of pocket maximum
- know your specialist office visit co-payment
- is a referral required?
We accept the following insurance plans:
Aetna Commercial Plans (Including Prisma Employees)
Aetna Medicare Advantage
Blue Choice Blue Option Exchange
Blue Choice Health Plan
Blue Cross Blue Shield (PPC/PPO/POS)
Blue Cross Blue Shield Reedy Exchange Plans
Blue Cross Blue Shield State and Federal Health Plans
Blue Cross Blue Shield SC Medicare Advantage
Blue Essentials Exchange
Cigna Commercial Plans
Cigna Medicare Advantage
Champ VA
Devoted Medicare Advantage (begins 2023)
EBMS
- EHN
Humana Commercial Plans
Humana Medicare Advantage Plans
Mail Handlers/GEHA
MedCost
Molina Health Exchange
Optum VA
Regional Health Plus (Spartanburg Regional Insured)
Planned Administrators (PAI) Preferred Blue
Traditional Medicare and Medicare Railroad
Tricare, Tricare for Life and Tricare Prime
- UMR – Bon Secours Employees (Flex Plan Only)
United Healthcare (UMR, Navigate, Golden Rule)
United Healthcare Medicare Advantage Plans
Wellcare Medicare Advantage Plans
Gastroenterology Associates is a participant in the following Accountable Care Organizations (ACO):
- Prisma Health Upstate Network, LLC
- No Surprises Act
The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. It also establishes an independent dispute resolution process for payment disputes between plans and providers, and provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the good faith estimate they get from the provider.
Starting in 2022, there are new protections that prevent surprise medical bills. If you have private health insurance, these new protections ban the most common types of surprise bills. If you’re uninsured or you decide not to use your health insurance for a service, under these protections, you can often get a good faith estimate of the cost of your care up front, before your visit. If you disagree with your bill, you may be able to dispute the charges. Here’s what you need to know about your new rights.
What are surprise medical bills?
Before the No Surprises Act, if you had health insurance and received care from an out-of-network provider or an out-of-network facility, even unknowingly, your health plan may not have covered the entire out-of-network cost. This could have left you with higher costs than if you got care from an in-network provider or facility. In addition to any out-of-network cost sharing you might have owed, the out-of-network provider or facility could bill you for the difference between the billed charge and the amount your health plan paid, unless banned by state law. This is called “balance billing.” An unexpected balance bill from an out-of-network provider is also called a surprise medical bill. People with Medicare and Medicaid already enjoy these protections and are not at risk for surprise billing.
What are the new protections if I have health insurance?
If you get health coverage through your employer, a Health Insurance Marketplace®, 1 or an individual health insurance plan you purchase directly from an insurance company, these new rules will:
Ban surprise bills for most emergency services, even if you get them out-of-network and without approval beforehand (prior authorization).
- Ban out-of-network cost-sharing (like out-of-network coinsurance or copayments) for most emergency and some non-emergency services. You can’t be charged more than in-network costsharing for these services.
- Ban out-of-network charges and balance bills for certain additional services (like anesthesiology or radiology) furnished by out-of-network providers as part of a patient’s visit to an in-network facility.
- Require that health care providers and facilities give you an easy-to-understand notice explaining the applicable billing protections, who to contact if you have concerns that a provider or facility has violated the protections, and that patient consent is required to waive billing protections (i.e., you must receive notice of and consent to being balance billed by an out-of-network provider).
What if I don’t have health insurance or choose to pay for care on my own without using my health insurance (also known as “self-paying”)?
If you don’t have insurance or you self-pay for care, in most cases, these new rules make sure you can get a good faith estimate of how much your care will cost before you receive it.
What if I’m charged more than my good faith estimate?
For services provided in 2022, you can dispute a medical bill if your final charges are at least $400 higher than your good faith estimate and you file your dispute claim within 120 days of the date on your bill.
What if I do not have insurance from an employer, a Marketplace, or an individual plan? Do these new protections apply to me?
Some health insurance coverage programs already have protections against surprise medical bills. If you have coverage through Medicare, Medicaid, or TRICARE, or receive care through the Indian Health Services or Veterans Health Administration, you don’t need to worry because you’re already protected against surprise medical bills from providers and facilities that participate in these programs.
What if my state has a surprise billing law?
The No Surprises Act supplements state surprise billing laws; it does not supplant them. The No Surprises Act instead creates a “floor” for consumer protections against surprise bills from out-of-network providers and related higher cost-sharing responsibility for patients. So as a general matter, as long as a state’s surprise billing law provides at least the same level of consumer protections against surprise bills and higher cost-sharing as does the No Surprises Act and its implementing regulations, the state law generally will apply. For example, if your state operates its own patient-provider dispute resolution process that determines appropriate payment rates for self-pay consumers and Health and Human Services (HHS) has determined that the state’s process meets or exceeds the minimum requirements under the federal patient-provider dispute resolution process, then HHS will defer to the state process and would not accept such disputes into the Federal process.
As another example, if your state has an All-Payer Model Agreement or another state law that determines payment amounts to out-of-network providers and facilities for a service, the All-Payer Model Agreement or other state law will generally determine your cost-sharing amount and the out-of-network payment rate.
Where can I learn more?
Still have questions? Visit CMS.gov/nosurprises, or call the Help Desk at 1-800-985-3059 for more information. TTY users can call 1-800-985-3059.
- Self-Pay Patients
Gastroenterology Associates offers discounted rates for those who do not have health insurance, who are underinsured, or who wish to pay without filing for insurance coverage. We request that payment be made in full at the time of service.
- If you choose our self pay option, we will not file insurance. Please call our billing department to discuss self-pay options.
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