Understanding Insurance

             Health insurance can be complex due to the various factors that contribute to its cost, coverage options, regulations, and provider networks. These factors can make it difficult for individuals to understand their options and make informed decisions about their coverage. This could lead to unexpected costs and financial burden if you need medical care that is not covered. We have compiled some information that may be helpful when reaching out to insurance about your coverage. GI Partners of IL does not check insurance coverage. We recommend patients to call their insurance to verify coverage. Write down the name of insurance representative, the date you called, and reference #.  Listed below are common questions to ask insurance.

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      Questions Patients Can Ask The Insurance Company

  • Is my procedure a covered benefit?
  • What is my responsibility for this procedure? Deductible, Max out-of-pocket?
  • What if I have a screening colonoscopy and a polyp is removed? Will I owe anything?
  • Is anesthesia covered under my plan?
  • Is the anesthesia provider in my network?
  • What if anesthesia provider is out-of-network?

                  Common Procedure Codes:                                                                                                                                                                                Anesthesia companies:

        EGD (Upper Endoscopy) 43235, 43239                                                                                                                       GSH Hospital: Barrington Anesthesia: 800-242-1131

        Dilation 43248, 43249                                                                                                                                                     Northwestern Hospital: Huntley Anesthesia: 847-457-3800

        Colonoscopy 45378, 45380, 45385                                                                                                         Pepper Road Endoscopy Center: GIP Anesthesia Services: 888-987-1489

        Coding Questions After Your Procedure: 

                 Coding is based on provider documentation. Patients with symptoms are not eligible for screening/preventative colonoscopy. EGD (Upper Endoscopy) is not a preventative procedure. Patients can mail the insurance company a written appeal if they do not agree with how the claim was coded.

         

        • Call insurance to ask for procedure code and diagnosis codes for all claims.
        • If there is a coding discrepancy, call the provider who billed claim.
        • Hospital claim: Call the Hospital
        • Anesthesia claim: Call the anesthesia company
        • Pathology claim: Call the pathology company
        • Provider claim: Call GI Partners at 815-401-1184 to ask for coding review.

        Appealing An Insurance Claim

                 If your health insurance company doesn’t pay for a specific health care provider or service, you have the right to appeal the decision and have it reviewed. You must send a written appeal to your insurance company. If you reached out to your insurance company prior to a test or procedure and the claim was not processed accordingly, the appeal should include the date and reference number from the original call.  For more information on how to send a written appeal, please reach out to your insurance company.