Insurance and Billing

Having a procedure such as a screening colonoscopy at a state-of-the-art MNGI Digestive Health endoscopy center is often less expensive than having the procedure performed in a hospital setting.

Even so, we understand that with recent increases in health insurance deductibles and other out-of-pocket expenses, many people are interested in the price of health care procedures and services prior to scheduling appointments. For your convenience and in our effort to support health care price transparency, MNGI Digestive Health now offers price information for some of our most common procedures and services. For other services and procedures not listed or to have a price quote mailed to your home, please contact our Business Office at 612-871-1145. 

NOTE: Because we cannot predict the outcome of your examination, we are unable to guarantee the exact dollar amount of your service. For instance, polyp and/or tissue biopsy during a screening colonoscopy will increase the cost of the procedure.

View our list of Service Price Quotes for an estimate cost for your visit.

MNGI Digestive Health offers several payment options for patients who may need assistance or additional time to pay their medical bills:

• Payment plan
• Financial hardship 

Payment plan

Depending on your situation, we may be able to offer you a monthly installment plan that allows you to pay your bill over a number of months.

Special circumstances

We understand that unexpected medical expenses can create financial hardship. We review patient circumstances on a case-by-case basis to assess eligibility for this special program. To be considered, a financial application must be completed and submitted to our Patient Account Department.

Other options

Additional Twin Cities resources for uninsured and underinsured patients are listed below. Call for eligibility requirements:

• United Way 211: 211 or (800) 543-7709
• St. Mary's Health Clinic: (651) 690-7029
• NorthPoint Health & Wellness Center: (612) 543-2500
• Southside Community Health Services (three locations)
  • Southside Medical Clinic: (612) 822-3186
  • Green Central Medical Clinic: (612) 827-7181
  • St. Croix Medical Family Clinic: (651) 430-1880

For more information, contact the MNGI Digestive Health Business Office at (612) 871-1145.

MNGI Digestive Health understands that health care costs can contribute to, and even cause, financial hardship. The following financial resources may be available to you and your family to help defray medical costs.

Payment Plan

If your bill is not entirely covered by your insurance plan(s), you will receive a statement from MNGI Digestive Health. If you had a procedure at one of our ambulatory surgery centers (ASC) you will also receive a statement from that facility.  And if monitored anesthesia care (MAC) is administered by an anesthesiologist and/or certified registered nurse anesthetist (CRNA) during your procedure, there will be additional charges billed. Payment in full is due upon receipt of these statements. However, if you are unable to remit full payment, please contact our Business Office as soon as possible to establish a mutually agreeable, interest-free payment plan.

MNGI Financial Assistance Program

If your income is not sufficient to cover your MNGI health care costs and you have been unable to set up a payment plan with our Business Office, you may be eligible for a partial or full discount through our own financial assistance program. 

Applications will only be considered after you have spoken with a representative from our Business Office. For more information, read through the Frequently Asked Questions listed below or call (612) 871-1145. 

What is the MNGI Financial Assistance Program?
Our financial assistance program is a partial or full discount available to patients who are unable to establish a mutually agreeable payment plan with our Business Office. The amount of the discount applied will be determined on a case-by-case basis according to your current financial situation.

Am I eligible for the MNGI Financial Assistance Program?
Eligible patients will have discussed their account balance with our Business Office and been unable to establish a mutually agreeable payment plan.

If we believe you may be eligible for assistance through a state or federal public health care program (i.e. Medical Assistance, MinnesotaCare, BadgerCare) and you have not yet applied, you will be required to apply for assistance before your application is considered.

Consideration will be based on your household income, expenses, family size and assets. Eligible households will have an annual gross income at or below 300% of the Federal Poverty Guidelines:

MNGI Digestive Health Financial Assistance Program
Eligible Household Income Amounts

After you complete our MNGI financial assistance application and submit the required supporting documentation, MNGI Digestive Health will review your application to determine if you qualify for a discount.

If I meet the income requirements for the MNGI Financial Assistance Program, am I automatically approved?
No. Meeting the income requirements for the program does not ensure approval as many other factors are considered.

What documentation is required for application to the MNGI Financial Assistance Program?
You must submit the following documentation with your completed application:

• State or federal public health care program determination letter - required regardless of whether your application was accepted or denied
• Your most recent federal tax return for you and your spouse*
• Your most recent bank statement(s) for you and your spouse*
• Pay stubs for you and your spouse from the past two months*

*If you are 18 or older and can be counted as a dependent on your parents'
income return(s), you must submit your parents' most recent return(s).

How long does the approval process take?
The approval process length varies, depending on whether or not additional documentation is required. However, the process generally takes about 10 to 14 business days after you provide us with all of the documents necessary to process your application.

Whose income must be included on the application for financial assistance?
If you are married, both spouses' incomes must be included on the application. If you are 18 or older and are counted as a dependent on your parents' income tax returns, both parents' incomes must be included.

Can I apply for financial assistance if I have insurance?
Yes. Any discount for which you qualify under the financial assistance program will be made after we receive payment from your insurance company.

What if I have already made payments on my account?
Discounts will be made on the remaining current balance. Refunds for previous payments will not be made.

How often do I need to apply for the program?
If you are eligible for the financial assistance program, a one-time discount will be applied to your account for all dates of service prior to receipt of your application. You will need to submit another application if you again require financial assistance on future medical care.

Translated Financial Assistance Applications

MNGI Digestive Health understands that health care costs can contribute to, and even cause, financial hardship. The following financial resources may be available to you and your family to help defray medical costs.

STATE AND LOCAL RESOURCES

State of Minnesota

There are resources available at the State and local levels.  The links below will lead you to websites where more information can be obtained.

• Minnesota Department of Human Services - Provides health care, economic assistance and social services for people who do not have resources to meet their basic needs.
• Minnesota Department of Health - Provides information on a variety of resources, such as how to find a local health care center and how to navigate through health care coverage options and procedures.
• NorthPoint Health & Wellness Center - Sliding fee scale clinic
• Southside Community Health Services - Sliding fee scale clinic
• St. Mary's Health Clinic - Free clinic

Surrounding States

The following organizations provide health care, economic assistance and social services for people who do not have resources to meet their basic needs.

• Iowa Department of Human Services
• North Dakota Department of Human Services
• South Dakota Department of Social Services
• Wisconsin Department of Health Services

Patient Assistance Programs

The following is a list of organizations which provide financial assistance for out-of-pocket healthcare costs. The diagnoses covered by each organization are noted.  Further eligibility requirements (such as insurance coverage, income level and covered medications) may vary for each organization.  If you have any questions about these organizations, our Patient Financial Counselor in the Business Office will be happy to assist you and can be reached at (612) 871-1145.

• Chronic Disease Fund (Colorectal Cancer, Crohn's Disease, Hepatitis B, Hepatitis C, Liver Cancer, Pancreatic Cancer)
• Healthwell Foundation (Crohn's Disease)
• Patient Access Network (Colorectal Cancer, Crohn's Disease, Hepatitis B, Hepatitis C, Pancreatic Cancer, Prostate Cancer)
• Patient Advocate Foundation (Colon Cancer, Crohn's Disease, Hepatitis C, Pancreatic Cancer, Prostate Cancer, Ulcerative Colitis)
• Cancer Care CoPayment Assistance Foundation
• American Cancer Society

The following organizations assist patients in finding available financial assistance programs based on disease group, medication, and/or geographic location.

• NeedyMeds
• Partnership for Prescription Assistance
• RxAssist

Patient Rebate/CoPay Assistance Programs

The following is a list of programs that can provide assistance with your medication out-of-pocket cost including deductible, co-payment and co-insurance.  For eligibility requirements or if you have any questions, please contact our Patient Financial Counselor in the Business office at (612) 871-1145 for assistance.

• Cimpay Co-Pay Savings Card
• Entyvio Patient Rebate Program
• Humira Protection Plan Card
• Inflectra Patient Rebate Program
• Janssen Care Path Patient Program for Remicade
• Remicade Patient Rebate Program and Simponi
• Stelara Patient Rebate Program

MNGI Digestive Health recommends that you call your insurance plan(s) prior to each new provider visit or service you receive to determine your specific benefits and coverage. Talking with your insurance plan(s) in advance does not guarantee coverage or payment for services, but will help you understand and prepare for any possible out-of-pocket health care expenses.

The following questions will help guide you through this process. If your insurance plan(s) inform you that you need additional information from MNGI before they can completely answer your questions, please call our Business Office at (612) 871-1145 and we will be happy to assist you.

For Any Service

Whenever you speak with an insurance representative, be sure to write down the date and time of the call as well as the name of the person with whom you spoke. You will be able to reference this information in the future should you need additional benefit information or need to appeal/dispute claims.

• Is this provider in network?
• What network level or tier is this provider a part of?
• What are the benefits for my upcoming service that are associated with this network level?
• Do I need a prior authorization for this service and/or facility?
• Do I need a referral for this service and/or facility?
• What benefits do I have for facility charges, if they apply?
• Do I have coverage to see a nurse practitioner or a physician assistant, or am I required to see a physician?

For Screening Colonoscopy

The following questions should be asked in addition to those above if you will be having a colonoscopy.

• Do I have screening or preventive care benefits?
• Is there a benefit cap on my screening or preventive care benefits? If so, what is it?
• Will my colonoscopy be covered under my screening or preventive benefits?
• My colonoscopy will be performed at an ambulatory surgery center (ASC). Are associated facility charges covered under my screening or preventive benefits? If not, what out-of-pocket expenses might I incur?
• What benefits do I have for pathology and lab charges? Are these covered under my screening or preventive benefits?
• What benefits do I have if my colonoscopy is not considered screening?

Colonoscopy Screening vs. Diagnostic Coverage

Allowed amount - The amount of the charge for the health care provider's service that the insurance company deems payable by the member's plan.

Claim - A statement of services and associated costs provided to a patient by a provider's office, ambulatory surgical center (ASC), hospital or other provider facility. Claims are sent to insurance plans (most often by health care providers) and are then processed to determine what, if any, payment the plan will make.

Co-insurance - A requirement of some insurance plans that a patient must pay a percentage of any remaining medical expenses after the deductible has been satisfied.

Co-payment - A requirement of some insurance plans that a patient must pay a specific dollar amount out-of-pocket for certain services and/or prescription medication at the time those services are received.

CPT (current procedural terminology) codes - Codes developed by the American Medical Association (AMA) to represent and describe medical, surgical and diagnostic services among providers, insurance plans and patients.

Deductible - A fixed dollar amount which must be paid by a patient before the insurance plan will begin to make any payments for services.

Encounter - Any health care visit by a patient to a health care provider where services are received.

EOB (Explanation of Benefits) - A document providing detailed information regarding how an insurance plan has processed a specific claim. The EOB includes how much of the health care costs have been paid to the provider by the insurance plan and what amount, if any, is the patient's responsibility.

ICD-9 codes - Codes developed to classify and communicate diseases and their associated signs and symptoms among providers, insurance plans and patients.

Medically necessary services - Services furnished by a health care provider to diagnose and treat a patient's illness or injury, which, as determined by a particular insurance plan, are:

• consistent with the symptoms, diagnosis, and treatment of the condition
• clinically appropriate in accordance with the applicable standard of care
• not primarily for the convenience of the patient, the patient's family or the health care provider
• furnished in the least intensive type of medical care setting required by the patient's condition

Network - The group of physicians, hospitals and other medical care providers with which a managed care insurance plan has contracted to provide health care services to its members.

NPP (Non-physician practitioner) - A health care provider, such as a nurse practitioner or a physician assistant, who is licensed to provide medical care under the supervision of a medical doctor.

Out-of-network - Health care providers who are not included in an insurance plan's network of contracted providers.  Services rendered by out-of-network providers usually result in greater out-of-pocket costs to the member (patient) than those provided by a network provider.

Out-of-pocket maximum - Dollar amounts set by insurance plans to limit the amount of money a patient must pay out of his or her own pocket for health care services during an established period of time.

Pre-certification (or prior authorization) - A requirement by some insurance plans that the health care provider must present advanced notification to the plan that a patient will be receiving a course of treatment. Some services may not be covered, if pre-certification is not obtained prior to treatment.

Pre-existing conditions - Health care conditions for which a patient has received health care services during the three months prior to the effective date of coverage for his or her insurance plan.

Referral - For health insurance purposes, a written authorization prepared by a primary care provider (PCP) or clinic that is sent to a patient's insurance plan to recommend that the patient see another health care provider (often a specialist).

Screening services - Services rendered for preventive purposes to determine if there may be a health condition present even if a patient has not experienced symptoms of the condition.

Screening vs. diagnostic colonoscopy - If you are not experiencing any symptoms (including, but not limited to, diarrhea, rectal bleeding or abdominal pain), which lead your doctor to recommend a colonoscopy, then your procedure is likely to be considered a screening procedure. However, if you have at least one symptom or complaint, the procedure can no longer be considered screening due to federal guidelines.

Usual and customary charges - The cost for a specific service commonly utilized by providers within a geographic area.