TDDC and Your Health Insurance
TDDC will work with your health plan representatives and your primary care physician to obtain prior authorization and, if necessary, referral for your gastroenterology procedure(s). Therefore, it is imperative that TDDC is furnished with your applicable and current insurance information. If any assistance from you is needed for this, our staff will contact you.
TDDC will seek to verify medical benefits to determine the eligibility of payment for the planned procedures under your health plan. If insurance verification indicates your services will not be covered, or that a significant portion of the cost will be your responsibility, our staff will contact you to discuss your payment options.
Employers now choose to purchase from a wide array of health care plans. Your health plan may have a benefit structure that will determine your out of pocket cost. Insurance verifications are done by telephone and information is usually verbally conveyed to our staff. We make every possible effort to obtain accurate benefits; however, our information is only as good as that provided by the health plan representatives. For this reason, we urge you to review the health plan coverage information given to you by your employer or insurer to gain your own understanding of your insurance benefits. You may also want to contact your human resources department at work for assistance in understanding your health plan coverage.
TDDC wants you to understand health plans may have different benefit structures for diagnostic services than for therapeutic/surgical services. Some services performed by gastroenterologists are done for health “screening” purposes (diagnostic) due to family history, personal history, or age of the patient. These same services can be performed because patients are experiencing signs or symptoms of illness and intervention/surgery may become part of the service provided.
Often for gastroenterology procedures labeling a procedure as diagnostic or therapeutic is dependent upon the findings at the time of the service. For example, a colonoscopy that is negative may fall under a health plan’s diagnostic screening benefit. A colonoscopy which reveals a polyp requiring removal or a need for biopsy might be paid under the surgical benefits of the same health plan.
TDDC wants you to be aware there will be charges related to your services from other health care providers including the out-patient facility in which you receive your care. The services of other specialists, such as pathologists or anesthesia providers, may also be required.
Hospital-based physicians such as pathologists or anesthesiologists may be out of network for your health plan, even if the hospital and the TDDC physician is in-network. TDDC physicians do not have control over other hospital-based providers’ health plan participation.
If you have any questions concerning your insurance benefits, it is your responsibility to contact customer service at your insurance company. They will be happy to help you with any questions that you might have.