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Billing & Insurance

Home Billing & Insurance

What Are the Payment Options Available at Smiles Gastroenterology?

You’re responsible for the payment of your hospital and clinic accounts. You may discuss financial arrangements at the Admissions and Business Services location that is most convenient for you.
For your convenience, Smiles accepts:

  • Discover, MasterCard, and Visa credit or debit cards. Contact Front desk services to make a payment.
  • Cash, cashier’s check or money order.
  • Wire transfers : Call Patient Account Services for wire transfer instructions.
  • ● Health savings account cards backed by the companies listed above. Please Call 8099008800 toll free Monday through Friday to pay your bill or ask questions about your statement.

What are the Insurance Types Accepted at Smiles Gastroenterology?

Smiles has established arrangements with several different types of health care insurers.
Uninsured (self-pay) or underinsured patients
You may be considered underinsured if you have a:

  • ● High deductible
  • ● High out-of-pocket maximum requirement
  • ● Limited benefit plan(s)
  • ● Non-contracted insurance plan

Note on non-contracted insurance plans: When you have non-contracted insurance, many insurance companies do not agree to Smiles rates; patients will have a greater out-of-pocket expense. Insurance rates can differ from Smiles rates, and you will be responsible for the difference.

Are there any Uninsured Discount Available at Smiles ?

Smiles Uninsured Discount Policy will supplement the Smiles Foundation and Financial Assistance Policy, which provides financial assistance.
All Smiles sites will offer discounted prices to qualified uninsured patients for medically necessary care.
Eligibility is contingent upon patient cooperation with efforts to apply for available Medical Assistance programs.
The uninsured discount will apply to medically necessary inpatient and outpatient services for patients residing in India.

Will I get any Financial Assistance at Smiles ?

In order to apply for financial assistance, patients will be required to apply for their state medical assistance plan.
Please know that the difference of these rates do not apply to your deductible or out-of-pocket maximum. Before your insurance pays, you will owe your co-insurance, copay and difference between the rates.

Insurance Approvals : Pre-certification and Prior Authorizations?

Your Smiles doctor will decide which procedures, tests and other consultations you may need. However, many health plans require pre-certification and sometimes predetermination of medical necessity prior to care being rendered. In addition, some services may not be a covered benefit for some plans. Investigating coverage requirements and limits can take up to six weeks, and some services require pre-certification staff to supply photos and medical necessity information to your insurance company.
For example, services that may require pre-certification include outpatient and inpatient hospital services, observation services, invasive procedures, CT, MRI and PET scans, and colonoscopies.
Patients are responsible for knowing the pre-certification requirements of their health plans Smiles highly recommends that you contact your insurance company to determine benefits and coverage for the Smiles location at which you plan to be seen.

  • ● Managed care plans such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs) may deny or reduce benefits if care is obtained outside of the established network or authorization of the plan.
  • ● Patients’ plans that require prior authorization or pre-certification may provide only a reduced insurance payment if not previously authorized. In such cases, the patient will be financially responsible for more — possibly all — of the provided services.
  • ● A pre-service deposit may be required for non-authorized visits.
  • ● To avoid paying a pre-service deposit or experiencing either denial of payment or a reduction of benefits, Smiles highly recommends you contact your insurance carrier prior to services to determine plan requirements or limitations to receiving care at the Smiles site at which you will receive services.

What are the Reasons for the Insurance Claims to be denied ?

  • ● Authorization number is missing or invalid
  • ● Benefits maximum for this time period has been reached
  • ● Care may be covered by another payer per coordination of benefits
  • ● Charges exceed your contracted/legislated fee schedule
  • ● Claim or service lacks information for payment processing
  • ● Insufficient or incomplete requested information
  • ● Lack of authorization or pre-certification prior to services
  • ● Lack of referral authorization
  • ● Motor vehicle or other liability insurance
  • ● Multiple physician assistants
  • ● Non-covered services or diagnosis code
  • ● Not an eligible dependent based on our records
  • ● Not medically necessary
  • ● Patient cannot be identified as our insured
  • ● Service deemed experimental/investigational or not proven to be effective
  • ● Usual and customary reductions (UCR)
  • ● Work-related injury or illness