Although every physician participates with different insurance plans, it is the goal of this organization to work with patients on all facets of their care, including their billing and insurance information.

Insurance information will be verified before appointments, and insurance claims related to individual doctors’ participation will be submitted for an assignment. We will supply any paperwork necessary to claim reimbursement for services that require direct payment. Coverage of lab work, pathology, and anesthesiology services will vary between insurance companies. As per organizational policy, up-front expenses as a result of co-pays, deductibles, co-insurance, etc. will become the sole responsibility of the patient.

The fee that we charge for our services covers the non-professional component of your procedure also known as the “technical” or “facility” fee which includes 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, anesthesia services, and possibly the laboratory for any pathology services. The facility, laboratory, and physicians’ professional office are all separate legal entities providing separate and distinct services.

All physicians providing services at our facility participate with the same plans that the “facility” participates with. Please contact your insurance carrier to understand if our other service partners (such as laboratory services for any pathology needs) participate with your insurance plans.

We expect all known co-payments to be paid at the time of service or as required by the contract between the patient, the insurer, and our center. We reserve the right to collect co-pays, deductibles, and coinsurance upon notification by the insurer.

Some insurers require pre-certification, pre-authorization, 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. If your insurance denies the claim, or holds payment, you may be ultimately responsible for the balance.

Insurances

Medicare (5/6/2015)
Medicaid (7/12/2004)
Aetna
– Commercial (3/16/2009)
– Medicare (3/16/2009)
AmeriHealth
– Commercial HMO/PPO, Medicare Adv (5/1/2014)
– AmeriHealth Regional
– AmeriHealth Medicare Advantage HMO/PPO (5/1/2014)
– AmeriHealth Value Network HMO/PPO (5/1/2014)
Cigna (11/1/2009)
Clover Health (1/1/2016)
Health Care Payers Coalition of New Jersey (12/1/2000)
Horizon BCBS of NJ
– Horizon BCBS Managed HMO (4/1/2006)
– Horizon BCBS PPO/Indemnity (4/1/2006)
– Horizon BCBS Medicare Advantage (4/1/2006)
MagnaCare (2/15/2008)
Multiplan/PHCS (9/1/2000)
PHCS Savility 9/1/2010
QualCare (includes Emblem Health-GHI &HIP)
PPO (5/15/2017)
HMO (5/15/2917)
Oscar NJ Individual & Family, Oscar NJ Small Group, Oscar NJ PPO, Oscar NY Small Group (1/1/2018)
Tricare Certified (11/1/2016)
United Healthcare
United Healthcare Commercial (3/1/2007)
– Medicare Advantage (3/1/2007)
– Community Care Network (Veterans) (6/26/2019)
– Oxford Health Plan (3/1/2007)

Anesthesia Clinical Services Provided by Northern Valley Anesthesiology PC
Anesthesia Billing Services provided by Garden State Endoscopy Center
1700 Galloping Hill Road, Plaza 138, Kenilworth, NJ 07033
(908) 241-8900