Billing and Benefits

Good Faith Estimates

On January 1, 2022, much of the No Surprises Act went into effect, including the requirement that we provide a good faith estimate of the cost of a procedure to our uninsured and self-pay patients. The estimates we provide include the facility and physician fees, the cost of anesthesia, and the cost of any pathology lab tests should they be performed. Estimates will be provided within one business day after scheduling when the procedure is scheduled at least 3 business days in advance, no later than 3 business days after scheduling when the procedure is scheduled at least 10 business days in advance, or within 3 business days of a request by a patient who is uninsured or self-pay and has not yet scheduled the procedure. Good Faith Estimates will be provided in writing, either on paper or electronically as requested by the patient. Estimates may also be given verbally, and will be followed by a written estimate. When providing an estimate for a colonoscopy, the facility and professional fees will be based on the removal of one polyp and obtaining one biopsy. The laboratory fees for two specimens and the anesthesia fees will also be included. Estimates for upper endoscopy will include the facility and physician fees based upon the cost of one biopsy. The laboratory fee for one specimen and the anesthesia fees will also be included. These estimates may be slightly higher than the actual costs if no polyps are removed or biopsies obtained. Any overpayment will be prompted refunded to the patient. Conversely, if additional treatments, polypectomies or biopsies are medically necessary and based on unforeseen circumstances that could not have reasonably been predicted at the time the procedure was scheduled, the actual costs might be higher than the given estimate. If an uninsured or self-pay patient receives a good faith estimate and then is billed by any of the providers or facility for an amount substantially in excess of the good faith estimate (at least $400 more by any of the individual providers), the patient is encouraged to contact our Accounts Manager to discuss the charges. The patient also may initiate a Patient-Provider Dispute Resolution (PPDR) and seek a determination by a Selected Dispute Resolution entity contracted with HHS for the amount to be paid. The Good Faith Estimate regulation does NOT apply to individuals who are enrolled AND filing a claim in a group health plan; group or individual health insurance coverage offered by a health insurance issuer; a federal healthcare program, or a health benefits plan under a Federal Employees Health Benefits (FEHB) Program. More information about your right to a Good Faith Estimate is available at www.cms.gov/nosuprises/consumers. A summary of this information is available on this website under Patient Rights & Privacy.

Understanding Your Co-Payments and Deductibles

We understand that medical bills and insurance terms can be very confusing. For this reason, we are providing the following information. Many patients believe that because they have insurance, they will not have to pay out of pocket for any part of their medical care. However, the amount you are required to pay for your medical care depends on your insurance policy. The portion you are obligated to pay (also referred to as the patient responsibility) may be in the form of a co-payment, coinsurance, or a deductible. Briefly, a co-payment is a fixed dollar amount that may be indicated on your insurance card. Co-payments are generally not very large, may vary according to the type of doctor or facility you utilize, and are always due at the time of your appointment. A coinsurance is similar to a copayment but it is not a fixed amount. Instead a coinsurance is calculated according to your insurance policy as a percentage of the cost of your medical care. For example, all Medicare patients have a 20% coinsurance. This means that for every $100 of your medical bill, you are responsible for paying $20. Some patients purchase a supplemental insurance to cover this 20% coinsurance. Lastly, a deductible is the amount that you must pay before your insurance will begin to cover your medical expenses. Nowadays it is not uncommon for patients to have deductibles of $1000 or more. In this example, the patient must pay for his/her first $1000 of medical care before his/her insurance will take effect. You can find out what your co-payments, co-insurances and deductibles are by calling your insurance company. Because we accept your insurance, we are required to collect your co-payments, co-insurances, and deductibles. Your insurance company will not pay any part of your bill for which you are responsible. As one of your health care providers, we kindly ask our patients to take care of their patient responsibilities promptly. If you have any questions regarding your account balance or you would like to work out a payment plan, please contact our business office at (302) 629-2536.

Delaware Screening for Life

Screening for Life provides payment for cancer screening tests to qualified Delaware adults. For more information, please click on "Important Links" under the "Patient Health Information" tab on this website.