Patient Forms

Financial Statement

The Center was established to meet the special needs of patients with gastrointestinal complaints or diseases. It is an “Ambulatory Surgery Center” specially designed for the practice of Gastroenterology — no other medical procedures are performed here. The physicians providing services at our facility are Board Certified in Gastroenterology and our clinical staff are trained professionals experienced in caring for our patients. The mission of the Center is to provide quality care in a specialized outpatient setting. Each patient will have our utmost careful and personalized attention.

By law, we are required to notify you that some of the physicians performing procedures here have a direct financial interest/ownership in this center.

In order to ensure that our patients understand their financial responsibility and our payment policies, we ask that you take a minute to read the following and discuss any questions you may have with our billing representative.

The fee that we charge for our services is intended to cover the cost of operating this facility including equipment, staff, rent, supplies, etc. You will also receive a separate bill from the physician’s office for their professional services.

As a courtesy to our patients, insurance claims will be submitted on the patient’s behalf to the insurance company specified during the registration process as long as we have the complete name and address of the insurance company, the subscriber’s name, social security number and birth date, and the group number and any other required pre-authorization for the procedure.

All co-payments and deductibles will be billed by Physicians Endoscopy’s billing department as required by the contract between the patient, the insurer and our center.

Some insurers require precertification, preauthorization or a written referral. It is the patient’s responsibility to understand the insurance plan requirements and ensure that the proper authorization is obtained at least 3 days prior to the date of service. Failure to do so may result in denial of the claim by the insurer. We cannot accept responsibility for a disputed claim. If your insurance company denies the claim for any reason or holds payment, you are ultimately responsible for the balance due.

We recognize that there may be times when full payment is not possible. Patients covered by insurers that our center has not contracted with or any patients without insurance are expected to pay a minimum of 50% of the procedure fee at the time of service and a minimum of one-third of the remaining balance over the three months following the date of service.

If you are having financial difficulty or have any questions, please contact our Billing Office to discuss your account at 866-950-2450. Payments are expected to be paid monthly and will be monitored. Non-payment of accounts after three months may result in referral to an outside collection agency that could impact the patient’s credit record.

Financial Statement

Schedule an Appointment

We are non-hospital based outpatient centers dedicated to providing the highest endoscopic services in a comfortable atmosphere. Our staff wants to make your visit as pleasant as possible. The centers are a place where patients receive quality care and then return to the comfort of their home the very same day.
Further contact details


About Us | Providers | Conditions | Procedures | Patient Forms | Contact Us

Privacy Policy | Privacy Notice | Sitemap | Nondiscrimination statement