Understanding Your Costs Before a Procedure
Because your procedure may involve services from multiple billing entities and your final responsibility depends on how your insurance processes each claim, there may not be one single estimate that represents the total cost of your procedure.
Start With Your Insurance Carrier
Your insurance carrier is the best place to start when trying to understand your expected out-of-pocket responsibility.
Peninsula Gastroenterology can provide applicable CPT and diagnosis codes upon request, when available. Having these codes, along with the provider and facility information below, may help your insurance carrier verify your benefits and provide an estimate of your responsibility.
Information You May Need
Peninsula Gastroenterology
Peninsula Gastroenterology participates with insurance plans through UCSF Clinically Integrated Partners.
NPI: 1265890263
Tax ID (TIN): 475502473
Your insurance carrier may have Peninsula Gastroenterology listed under UCSF Clinically Integrated Partners rather than “Peninsula Gastroenterology.”
Atherton Endoscopy Center
If your procedure will be performed at Atherton Endoscopy Center:
NPI: 1316291867
Tax ID (TIN): 460842370
Atherton Endoscopy Center may appear in your insurance carrier's system as Pacific Endoscopy.
Questions to Ask Your Insurance Carrier
- Is Peninsula Gastroenterology / UCSF Clinically Integrated Partners in network with my specific plan and network using the NPI and Tax ID listed above?
- Is the facility where my procedure will be performed in network with my specific plan and network?
- Is the specific service or procedure covered under my plan?
- Is a referral or authorization required?
- What is my remaining deductible, and will it apply to this service?
- Will I have a copay or coinsurance? If so, how much?
- If I have coinsurance, can you provide an estimated dollar amount based on the CPT code(s)?
- If the provider or facility is out of network, does my plan include out-of-network benefits?
- Are there any other requirements I should complete before receiving the service?
- If I am having a screening colonoscopy, how will my benefits apply if a polyp is removed or a biopsy is performed?
- If I am having both an EGD and colonoscopy, how will my benefits apply to each procedure?
Please keep in mind: Information provided by your insurance carrier before services are rendered is an explanation of your current benefits and does not guarantee how a future claim will be processed.
If You Need Additional Cost Information
If you need additional information after reviewing your benefits with your insurance carrier, Peninsula Gastroenterology may be able to provide an individualized estimate of your expected patient responsibility for Peninsula Gastroenterology professional services upon request.
The estimate is based on the anticipated services and insurance information available at the time it is prepared. It is not a guarantee of your final out-of-pocket responsibility, which may vary based on your insurance benefits, how your claim is processed, and the services actually performed.
A Peninsula Gastroenterology estimate applies only to our professional charges and does not include facility, anesthesia, or pathology charges.
For procedures, Peninsula Gastroenterology submits our claim to your insurance first and bills you for any remaining patient responsibility after your insurance processes the claim.
Atherton Endoscopy Center Facility Estimates
Atherton Endoscopy Center calculates its own estimate for the facility portion of your procedure and collects the estimated patient responsibility on the day of your procedure.
The Atherton Endoscopy Center estimate applies only to its facility services and does not represent the total expected cost of your procedure.
Questions about the facility estimate, payment collected on the day of your procedure, final facility balance, or any potential adjustment or refund should be directed to Atherton Endoscopy Center Facility Billing at (650) 263-4417.
An Estimate Is Only One Piece of the Picture
An estimate from Peninsula Gastroenterology or Atherton Endoscopy Center represents only that entity's portion of your care. An estimate from one entity should not be interpreted as the total expected cost of your procedure.