Understanding your insurance plan

This guide will help you through any insurance-related steps you may need to take prior to your procedure. Because each health insurance plan is different, we still recommend that you contact your insurance company to better understand your unique benefits and plan requirements.

If you have any questions, please contact 904-398-7205 and ask to speak with a financial counselor. 

 


 

If you are scheduleD to visit our office

Prior to your office visit, please contact your insurance company to ask or verify the following information:

  • Is your Borland Groover physician in-network or considered out-of-network?
  • Does your plan require a referral from your primary care physician? If so, verify that it was sent to our office.
  • What is your copayment amount for a specialist? This amount may be different than your primary care physician.
  • Do you have an out-of-pocket deductible?
  • Does your plan have a coinsurance amount?
  • Before you end the call, obtain a reference number.

As a courtesy, we will contact your insurance company to verify benefits, but this is limited to:

  • Effective dates of coverage
  • Amount due at the time of service (copay/coinsurance)

Borland Groover is not able to verify if our physician is in-network or out-of-network for your unique insurance plan. If a referral is received, our staff will file the referral in your medical record.

Click here for a printable guide to help you through the above insurance-related steps you may need to take prior to your office visit.

 

If Your Physician Scheduled You for a Procedure

If your Borland Groover physician recommends that you have a procedure, it could be scheduled at one of our accredited endoscopy centers or hospital outpatient facilities. It’s important to contact your insurance carrier to discuss your scheduled procedure. For most insurance companies, verification of benefits does not mean a guarantee of payment for the procedure.

Contact your insurance company to ask or verify the following:

  • Notify your insurance carrier of your procedure.
  • Does your plan require pre-authorization or a notification of the procedure?
  • Is the facility in-network?
  • What amount will your plan pay for the procedure?
  • If applicable, verify any out-of-pocket amounts for the procedure.
  • Before you end the call, obtain a reference number.

 

Once the procedure has been scheduled, our financial counselor will:

  • Contact your insurance company to verify benefits.
  • Verify if a pre-authorization or notification is required.

If the facility or physician is out-of-network or you have a high deductible to meet, inquire about payment plan options.

If a procedure is performed in a Borland Groover facility, we will verify the amount due at the time of service and contact you with the estimated amount. If the procedure is scheduled in a hospital facility, the hospital will be responsible for verifying your benefits.

Click here for a printable guide to help you through the above insurance-related steps you may need to take prior to your procedure.