Centers for Gastroenterology (CFGI) recommends that you call your insurance plan(s) prior to each new provider visit or service you receive to determine your specific benefits and coverage. Talking with your insurance plan(s) in advance does not guarantee coverage or payment for services, but will help you understand and prepare for any possible out-of-pocket health care expenses.The following questions will help guide you through this process. If your insurance plan(s) inform you that you need additional information from CFG before they can completely answer your questions, please call our Financial Services at 970-207-9773, and we will be happy to assist you.
For Any Service
Whenever you speak with an insurance representative, it is recommended any time you speak with an insurance company to obtain a reference number, name of the person you spoke with, date and time for your files. You will be able to reference this information in the future should you need additional benefit information or need to appeal/dispute claims.
- Is this provider in network? Is the facility in network?
- What network level or tier is this provider a part of?
- What are the benefits for my upcoming service that are associated with this network level?
- Do I need a prior authorization for this service and/or facility?
- Do I need a referral for this service and/or facility?
- What benefits do I have for facility charges, if they apply?
- Do I have coverage to see a nurse practitioner or a physician assistant, or am I required to see a physician?
For Screening Colonoscopy
The following questions should be asked in addition to those above if you will be having a colonoscopy.
- Do I have screening or preventive care benefits?
- Is there a benefit cap on my screening or preventive care benefits? If so, what is it?
- Will my colonoscopy be covered under my screening or preventive benefits?
- My colonoscopy will be performed at an ambulatory surgery center (ASC). Are associated facility charges covered under my screening or preventive benefits? If not, what out-of-pocket expenses might I incur?
- What benefits do I have for pathology and lab charges? Are these covered under my screening or preventive benefits?
- What benefits do I have if my colonoscopy is not considered screening?