We encourage you to review your insurance coverage prior to your visit with Texas Midwest Gastroenterology Center, PA. It is important for you to understand the extent of your health insurance coverage and the responsibilities you have as part of that coverage.
Referrals and Authorizations
Referrals – You are required to 1) know whether or not your insurance requires a referral; and 2) obtain that referral before you are scheduled to see our providers. You should take the time to call your insurance company to ask specifically about your covered benefits. Referrals typically have an expiration date and a limited number of visits so you should be careful to monitor the dates and visits.
Note: Most primary care physicians require at least 48 hours’ notice be given for them to prepare a referral and sometimes require an appointment with their office prior to initiating the referral.
Co-Payments/Co-Insurance and Deductibles
As a courtesy to our patients, we will file claims on all visits and procedures, whether they are delivered in our office or the hospital. When we file a claim on your behalf, it is with the understanding that benefits will be assigned to Texas Midwest Gastroenterology Center, PA (that is, the insurance company will pay TMGC directly). You are responsible for payment of all deductibles, co-insurance and non-covered services. Please remember insurance coverage is a contract between the patient and the insurance company. The ultimate responsibility for understanding your insurance benefits and for payment to your doctor rests with you. Through our contract with your insurer, we are required to collect payment of deductibles and co-pays for services at the time of service. For your convenience, we accept cash, debit, and credit cards.
Self Pay/No Insurance
Patients who do not have insurance are expected to pay for all services rendered. We will request a payment for outpatient procedures in advance of having the procedure performed.
Out of Network Services
TMGC does not make any guarantees that any laboratory, anesthesiology or other professional services are in-network providers for your contracted insurance plan. You are responsible for any professional charges in conjunction with the services you receive at the facility whether these services are considered in or out of network with your insurance plan.
With numerous insurance companies accepted at our facility, this increases your chance to have access to our affordable services. Please see the list of insurance companies accepted; however, please keep in mind our contracts with insurance companies are subject to change and occasionally lapse, so it’s a good idea to verify with your insurance plan prior to your visit.
You have scheduled a visit with one of our physicians or nurse practitioners that the physician believes to be relevant to evaluate, monitor and protect your health; however, Medicare and certain other insurance companies will only pay for services that they determine to be “reasonable and necessary.” If Medicare or another insurance company determines that your visit with our physician or nurse practitioner is not “reasonable and necessary,” then they will deny payment for that service. Sometimes insurance companies will not cover an office visit prior to a procedure when the patient comes to the doctor with no symptoms and is requesting a screening procedure. Denial of payment by your insurance company does not mean that you do not need to visit with the physician or nurse practitioner beforehand.
An office visit prior to the performance of any procedure is necessary in order to evaluate the patient’s general health. In addition, this will ensure that the patient is well informed about any recommended procedure and allow the opportunity to obtain Informed Consent for the procedure. We are required to inform you that your insurance company may not cover the office visit and that you will be responsible for payment.