Financial Information

Digestive Disease Associates accepts Medicare, Medicaid, most commercial insurance carriers.

Most insurance companies have criteria to determine whether they feel a service is “medically necessary”. This often means that each type of service is linked with certain diagnoses for which that service has been deemed appropriate. If your diagnosis does not meet the criteria for “medically necessary”, your claim may be denied. This does not mean that the service was inappropriate or unnecessary.

Q. Will my insurance cover my colonoscopy?

A. The Affordable Care Act, passed in March 2010, covered several preventative services, such as screening colonoscopies, at no cost to the patient. This ensures that colorectal cancer screening is available to privately insured patients at no additional cost.

Q. Can the physician change, add, or delete my diagnosis so that I can be considered eligible for a colon screening?

A: This happens a lot. The insurance representative often tells the patient that if the "doctor had coded this as a screening, it would have been covered." However, further questioning of the representative will reveal that the "screening" diagnosis can only be amended if it applies to the patient. Remember that many insurance carriers only consider a patient over the age of 45 with no personal or family history as well as no past or present gastrointestinal symptoms as a "screening" (Z12.11)

If you are given this information, please document the insurance representative's date, name, and phone number. Next, contact our billing department to audit the billing and investigate the information given. Often, the outcome results in the insurance company calling the patient back and explaining that the member services representative should never suggest that a physician change their billing to benefit a patient's coverage.

We accept most major insurance plans. HMO insurance plans often require a referral from your physician and an electronic authorization your primary care physician has to request from your insurance company. If you are insured with an HMO plan, please have both your referral and electronic approval in place before requesting an appointment. Completing this step will avoid scheduling delays and guarantee your insurance plan is aware of your visit.

• Co-payments are due at time of service
• Bring a Photo I.D.
• Bring insurance card(s)
• Bring a list of current medications and dosages
• Bring completed forms. Complete forms online at ddadocs.com
• Patients are responsible for obtaining any referrals and knowing the requirements of their insurance carrier, including pre-certification
• Patients are financially responsible to Digestive Disease Associates for non-payment of any fees not covered by your insurance
• Account statements are mailed monthly
• Physician, facility, and pathology charges are billed separately

For assistance or pre-certification approval, including payment plan options, please contact us at billing@gainesvillegi.com or call us at 352-331-8902 and select option 7.