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.
See Understand Your Insurance for more details.
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.