FEE STRUCTURE: General Guidelines
Endoscopy (EGD) + Colonoscopy are methods of evaluating and/or treating the upper digestive tract as well as lower digestive tract using endoscopic equipment. In the majority of cases, they both can be done during the same session. This way, only one anesthesia session will be required. In addition, the overall cost of procedures is significantly reduced when both are done during the same session of anesthesia.
The determination of whether BOTH endoscopy and colonoscopy can be done in one session or, whether one or both are medically necessary, requires clinical judgment by the physician. Therefore, a consultation/visit is routinely required before these procedures to discuss benefits/risks and possible alternatives.
There are DIFFERENT pricing models available:
- Medicare Patients: Medicare pays for this service. Patients pay their share of deductible and coinsurance. Unless there are unusual circumstances, such as a pre-op evaluation done by another doctor, an initial visit is required before the procedure. Appointments are offered based on availability.
- For ALL other patients, including patients without insurance (“cash pay”), we have made accommodations to make the test as affordable as possible. If you are an established patient and have seen our doctor, we can provide the financial details after your visit. This is the best scenario. Otherwise, if you are simply interested in a quote, please provide us with the following information:
- Your name and date of birth.
- Referring doctor, if any.
- Are you currently under the care of a primary care physician?
- Are you covered under PPO insurance? If yes, please provide details.
- Do you plan to submit a superbill to insurance for possible reimbursement?
- Do you have any of the following conditions that add to complexity of medical conditions? Examples:
- Diabetes controlled with insulin
- Seizure disorder
- Cardiac disease
- History of heart attack (myocardial infarction)
- Using blood thinners of any sort (other than preventive use of aspirin)
- Neurological disorder, such as history of stroke
- Generally speaking … age above 65
- Lung disease, COPD, active asthma, etc.
- Anxiety and panic disorder
- On two or more medications
- Pregnancy or planning for one
- Having active symptoms, such as diarrhea, weight loss, difficulty swallowing, abdominal pain, etc.
- Active infection
- More …
Patients with any of the above conditions need to be formally evaluated under our Comprehensive Consultation Services before proceeding with any outpatient procedure that requires anesthesia or has a remote inherent risk.
For a more comprehensive list of complex conditions, which still may not be all inclusive, please see the attachment (PDF).
If you are patient with medical conditions that may increase your overall risk of the procedure, please let us know in advance. The “Basic BEFORE Colonoscopy/Endoscopy Visit” may not be sufficient to evaluate patients with complex medical problems. Examples of medical complexity problems are shown above. These patients would require more comprehensive evaluation prior to their procedures to assess benefits and risks and implement any precautions.
COMPONENTS OF COSTS FOR COLONOSCOPY AND/OR ENDOSCOPY:
- Facility Fee
- Doctors Fee for the Procedure