Billing

For questions about bills, current balance due, or all other questions related to billing, please call 832-371-9044. Billing fax: 866777-8553.

Billing Policy

Thank you for choosing Texas Gastroenterology Center PLLC (Dr. Muhammad Osman Arif) for your medical care. We are committed to providing high-quality medical services while also keeping our billing process clear and transparent. This policy outlines our billing procedures and expectations.

Insurance

We accept most major insurance plans. The amount of payment for a particular service is determined by the contract that our providers have with your insurance provider. Your insurance plan will determine the amount to be paid by the insurance company and what is your responsibility. IT IS YOUR RESPONSIBILITY TO ENSURE THAT YOUR INSURANCE PLAN COVERS THE SERVICES YOU RECEIVE. We will verify insurance coverage and bill the insurance company directly for services rendered. YOU MAY BE BILLED FOR THE COST OF SERVICES RENDERED IF THE INSURANCE COMPANY REFUSES TO PAY.

Co-Pays, co-insurance and Deductibles

Co-pays, coinsurance and deductibles for office visits are due at the time of service. We accept cash, checks, and credit/debit cards. If you are unable to pay your co-pay or deductible at the time of service, we may cancel/reschedule your appointment. We try to obtain your eligibility information from your insurance company however, in some instances, the deductible may not have been updated. In that case, we will collect from you based on the available information from the insurance company. It is highly recommended that you place a credit card on file so that it may be charged for any outstanding charges after the insurance bill has been processed or refunded if there has been an over collection. It is highly recommended that you save your receipts for all payments. Co-pays, coinsurance and deductibles for procedures are due at the time of scheduling or before the procedure. If you cancel your procedure, these will be refunded minus any late cancellation/no show fees if applicable based on our no show policy.

Self Pay :

Our self pay rate is $250 for new visit and $150 for follow up. Self pay rates for procedures will vary depending on the type of procedure being performed. Please discuss with the staff at the time of scheduling.

Billing Statements

Your insurance company should send you an Explanation of Benefits (EOB) after every bill has been processed. Please refer to the EOB for details of the amount paid by the insurance company for the service provided and the amount that you are responsible for. These vary based on your insurance plan and policy. We will send you a billing statement for any outstanding balance after your insurance company has processed your claim. Payment is due upon receipt of the statement. If you are unable to pay the entire balance at once, please contact us to set up a payment plan. Please ensure that your home address and email address on file are correct and updated. If you find that you have overpaid what you were responsible for, please contact us immediately so that the overpaid amount can be refunded. Kindly provide a copy of your receipt.

You will be asked to pay any pending balances on your account at the time of your next appointment. It is extremely important that you pay your balance when it is due. We greatly appreciate your cooperation in this regard.

Collections

Accounts with balances greater than 90 days past due will be referred to a collection agency. Patients with outstanding balances may be dismissed from our practice.

Questions or Concerns

If you have any questions or concerns about our billing policy, please contact us at 214-216-6564. Medical Billing can be complicated and confusing at times. We are happy to work with you to resolve any issues and ensure that your billing experience is as smooth as possible.

Thank you for choosing Texas Gastroenterology Center PLLC (Dr Muhammad Osman Arif) for your medical care. We appreciate your trust in us and look forward to serving you in the future.

Screening Colonoscopies

Most insurance plans will pay for a screening colonoscopy every 10 years.

Colonoscopy: Screening vs. Diagnostic

Most health insurance plans cover health maintenance and physical exams as long as ONLY preventive health topics are addressed and recommended screening tests are performed. What is the difference between a “screening” colonoscopy and a “diagnostic” colonoscopy? A “screening” colonoscopy is a colonoscopy that is done for the prevention of colorectal cancer and is considered a preventive health service.
A screening colonoscopy will have no out-of-pocket costs for patients (such as co-pays or deductibles).
A “diagnostic” colonoscopy is a colonoscopy that is done to investigate abnormal symptoms, tests, prior conditions or family history. A diagnostic colonoscopy may include out-of-pocket costs for patients (such as co-pays or deductibles), depending on your insurance plan.
At this time, a colonoscopy can be considered a “screening” colonoscopy only if ALL of the following are true:
- 45 years or older
- No symptoms
- No prior abnormal testing
- o prior history of colorectal problems
- No family history of colorectal polyps or cancers

What if I have any symptoms?

If you have any symptoms that could be related to a colon or rectal problem such as abdominal pain, diarrhea, constipation, blood in the stool or weight loss, then your colonoscopy is considered a “diagnostic” colonoscopy.

What if I have a prior history of colorectal problems?

If you have a prior history of colon or rectal problems such as a history of polyps, cancer, ulcerative colitis or Crohn’s disease, then your colonoscopy is considered a “diagnostic” colonoscopy.

What if I have a family history of colorectal polyps or cancer?

If you have any family history of colon or rectal cancer or polyps, then your colonoscopy may be considered a “diagnostic” colonoscopy, depending on your insurance plan.

What if I had abnormal blood, stool, or radiology tests?

If you have any abnormal blood tests such as low blood counts (anemia) or low iron counts, then your colonoscopy is considered a “diagnostic” colonoscopy.
If you have any abnormal stool tests such as FOBT, FIT or Cologuard, then your colonoscopy is considered a “diagnostic” colonoscopy.
If you have any prior radiology tests such as X-rays, CT scans or MRI scans that show abnormalities in your colon or rectum, then your colonoscopy is considered a “diagnostic” colonoscopy.

What if a problem is found during a “screening” colonoscopy?

If you undergo a “screening” colonoscopy and something is found during the test (like a polyp or other abnormal area) that requires a biopsy or removal, then the colonoscopy may no longer be considered “screening.” Your insurance plan may then consider this a “diagnostic” colonoscopy where you may be charged a co-pay or deductible.

Procedure billing process

If you are scheduled for an endoscopy procedure, the procedure will be scheduled at another facility, a hospital, or an endoscopy center. Every endoscopic procedure will typically generate 4 different bills:

Physician fee
Facility fee
Anesthesia fee
Pathology fee

Most likely, your insurance plan will be billed separately for the above services.
If you have a deductible on your plan that has not been met, you will have to pay out-of-pocket for the services depending on the balance of your deductible. Once your deductible is met, your insurance plan may have a coinsurance that will require you to pay a percentage of the procedure cost. Once you meet your out-of-pocket maximum, your insurance plan should pay for all covered services.

At this office, we will only collect the portion of the physician fee that you are responsible for, based on your deductible or coinsurance if applicable, before the procedure.

We can provide you with a good-faith estimate of the facility, anesthesia, and pathology fees. We encourage you to contact the respective facility, anesthesia and pathology offices for information about your out-of-pocket costs associated with the procedure. Please refer to the scheduling instruction sheet for phone numbers to call based on where your procedure is scheduled.

If Medicare is your primary insurance, you will typically have a 20% coinsurance. If you have secondary insurance, they will usually cover the coinsurance amount, eliminating the need for any out-of-pocket costs.

Prior authorization from the insurance company may be required before your procedure, however, that does not guarantee that the insurance company will cover the procedure cost. The ultimate decision lies with the insurance company. We encourage you to contact your insurance provider before your procedure to discuss your financial responsibility.

If you are scheduled for a screening colonoscopy, the procedure is typically not subject to deductible or coinsurance. However, if you have a previous history of polyps and your last colonoscopy was less than 10 years ago, your colonoscopy may be subject to deductible and/or coinsurance if applicable depending on your insurance plan. Please call your insurance plan representative to discuss their coverage terms.

The final cost of the procedure may vary based on the actual procedure performed. This may result in a residual balance due from you, or a refund owed to you. At the time of scheduling, we will ask that you place your credit card on file. Please keep your receipt of any payments that you make before your procedure and compare that with the explanation of benefits (EOB) provided to you by your insurance company, typically sent 2-3 weeks after your procedure. If you owe a balance, we will charge your credit card on file, send you a bill by mail or email or call to collect that payment. If you overpaid (not common), we can apply that amount to your next appointment or issue you a refund to your original form of payment. We have a dedicated billing team that works very hard to get the most updated information from the insurance plans, however, this is a very complicated process prone to errors. We strive to make this process as smooth as possible and transparent.

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