Insurance Information

 

 

Accepted Insurance Plans

Aetna
BlueCrossBlueShield of Michigan
Blue Care Network
Cofinity
HAP
Health Plus of Michigan
Medicaid
Medicare
Priority Health
United HealthCare
 

Aetna Choice POS II (Aetna HealthFund & Open Access)

Aetna DC & MD Bronze, Silver, & Gold OAMC

Aetna Open Access Elect ChoiceEPO (Aetna HealthFund)

Aetna Open Access Managed ChoicePOS (Aetna HealthFund)

Aetna Select

Aetna Select (Open Access)

Aetna Elect Choice EPO

Aetna Elect Choice EPO (Open Access)

Aetna Managed Choice POS

Aetna Managed Choice (Open Access)

Aetna Open Choice PPO

Aetna Medicare Advantage

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BCBSM Traditional, Trust, PPO, & Federal

BCBSM Blue Preferred Plus

BCBSM Blue Choice

BCBSM Community Blue

BCBSM Trinity Tier 1

BCBSM U of M Premier Care

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BCN (Blue Care Network)

BCN Advantage

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Cofinity (formerly PPOM)

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HAP – Alliance Health & Life

HAP – Alliance Medicare PPO

HAP – HMO, PPO, POS, EPA, EPO

HAP – Self Funded HMO/POS Henry Ford Health System

HAP Preferred

HAP Preferred TPA Cigna

HAP Senior Plus HMO-POS

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Health Plus of Michigan HMO & PPO

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Medicaid

Medicaid – Meridian

Medicaid – Midwest HAP

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Medicare  

Medicare Plus Blue PPO 

Medicare Railroad

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Priority Health HMO, PPO, &POS

Priority Health Medicare

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UHC - United HealthCare

UHC - Core HMO, EPO, & Choice Plus POS

UHC – Choice EPO, HMO, & POS

UHC – PPO

UHC – Select EPO, HMO, POS

UHC – Navigate EPO & HMO

UHC – Charter EPO, HMO, & POS

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You are scheduled for a colonoscopy with Huron Gastroenterology (HG).  Colonoscopy is one screening method recommended by the American Cancer Society and other professional organizations. The physicians of HG agree that a colonoscopy is the most effective means of screening. 

Because the terminology used for your colonoscopy can be confusing, let us attempt to help you better understand the terms your physician or your insurance company may use and the related payment methods.

“Screening” and “surveillance” are two terms that often cause confusion and can have different reimbursement outcomes.  Even though your physician may order a “screening” colonoscopy, your insurance company may consider it a “surveillance” colonoscopy.  If your insurance company processes the charge as a surveillance procedure, you may have some out-of-pocket expenses you did not anticipate.  For this reason, we encourage all patients to contact their insurance company prior to their procedure.  In order to help you better understand some of the possible cost sharing that may occur and to assist you during your call with the insurance company, we have included some information below regarding “screening”, “surveillance”, and diagnostic/therapeutic colonoscopies.

Payers Have Three Colonoscopy Categories:

SCREENING COLONOSCOPY
G0121 (CPT) Routine Screening Colonoscopy
Z12.11 (Diagnosis Code) Screening of the Colon
Definition:  A screening colonoscopy is performed once every 10 years for asymptomatic patients over age 50 with no history of colon cancer, polyp, and/or gastrointestinal disease. 

SURVEILLANCE COLONOSCOPY
G0105 (CPT) High Risk Colonoscopy
Z86.010 Personal History of Polyps
Z80.0 Family History of Colon Cancer
Definition:  The patient is asymptomatic (no gastrointestinal symptoms either past or present),
has a personal history of gastrointestinal disease, colon polyps, and/or cancer.
 Patients in this category typically are required to undergo colonoscopy every 2 – 5 years. 
Depending upon on your insurance carrier, surveillance colonoscopy could be processed under your screening benefits or diagnostic benefit and may have some cost share. 

DIAGNOSTIC / THERAPEUTIC COLONOSCOPY
45378, 45380, 45385, G0105 (typically)
Definition:  The patient has past/or present gastrointestinal symptom(s), polyps,
or gastrointestinal disease. 

In the event an abnormality is seen or suspected during the procedure, a portion of tissue (biopsy) may be removed or small growths (polyps), if seen, may be removed.  Depending on your insurance coverage, this could be processed under your screening benefits or diagnostic benefit and may have cost share.  

You may receive bills from separate entities associated with your procedure such as the facility, anesthesiology, pathology, and/or laboratory.  If your procedure is scheduled at Center for Digestive Care, we can only provide you information based on our fees (professional, anesthesia, and facility), not ancillary fees such as pathology.

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