What You Should Bring With You
- Photo lD. Please note, if your address differs from what is printed on your driver's license or other photo ID, please bring a change of address card or a utility bill or other correspondence that shows your name and correct address. We appreciate your cooperation with our efforts to protect your identity and comply with federal regulations.
- Insurance card(s)
- Insurance Referral Form; if applicably to your insurance policy.
- Completed Patient Registration and Interview forms, if not submitted online. Please read and sign all financial, insurance, and contact areas on forms.
- Current medication list and/or containers/bottles including any supplement(s) or herb(s).
- Your personal\work calendar so you may schedule a date/time for any testing and/or procedures your physician may order.
- Payment for co-pay, co-insurance, or deductible.
Patient Forms
At Gastroenterology Associates, we value our patients time and privacy. Our Patient Registration form, Patient Interview form, and Statement of Privacy Practices are available for your review and completion.
Each New Patient will be required to complete the following forms. You may either complete both forms online to submit or print to complete for your scheduled appointment.
Insurance
Our Practice accepts a wide variety of insurance plans and programs such as Aetna, Cigna, Medicare, Maryland BlueCross BlueShield, Maryland Medicaid, United Healthcare. If you have questions about your coverage you may call our office 301-733-4404 before your visit to confirm coverage
Financial Information
Your insurance coverage is an agreement between you and your insurance company. You are financially responsible for co-pays, deductibles, co-insurances, and non-covered services, We will ask you to sign an authorization form requesting insurance payments be sent directly to our office.
Insurance Referral forms must be presented to our office at the time of your appointment for all HMO insurances; otherwise, any charges will be your responsibility
All co-pays, co-insurances, deductibles, Medicare co-insurance are due at time of service. If you are unable to make payment, please contact our office to make arrangements otherwise your appointment may be rescheduled. Our practice accepts cash, check, Visa, Mastercard, Discover, American Express, and Care Credit.
Checks should be made payable to: Gastroenterology Associates. Any returned check(s) to our practice as unpaid will be charged a $50 fee.
Account balances are invoiced every 30 days. You may mail your payment to the practice or pay on line at www.gidoc.biz with a credit card, debit card, or HSA card. On line payments must be greater then $10.00
Failure to show up for office appointments may result in a $25 charge. This is not billable to your insurance plan.
Failure to show up for endoscopic procedure may result in a $75 charge. This is not billable to your insurance plan.
We require a $150 deposit on procedure(s). The deposit is based on your insurance coverage type. The deposit is due prior to your procedure date. If you are unable to make payment, please contact our office to make arrangements.
We do not refund credits on patient accounts under $5.
Please direct all questions regarding billing, fees, or medical insurance to our billing staff. If you have questions as to whether our practice participates with your insurance plan please contact our office.
If you are experiencing financial circumstances beyond your control, our practice, as a courtesy, will establish a reasonable monthly payment plan to accommodate your needs.
Gastroenterology Associates will apply a 25% collection fee to all delinquent account with no payment over 90 days. Your account will be turned over to our collection agency for processing and payment collection. Additional fees may result from attorney or court costs involved in collecting balances due to nonpayment on your account.
Cancellations, missed, and rescheduled appointments and/or procedures
We request that you contact our office to cancel or reschedule your appointment and/or endoscopy procedure a minimum of 2 business days in advance. This will give our office ample time to refill the open appointment with a patient who needs to be seen. Our office reserves the right to charge a $25.00 fee for multiple missed, rescheduled, or cancelled appointments. And Charge a $75.00 fee for failure to show up for an endoscopy procedure. These fees are patient responsibility and are NOT billable to your insurance carrier.
Multiple missed, rescheduled, and/or cancelled appointment or procedure may result in your discharge from our practice.
