Save time in the waiting room! Please print and complete the following forms before your appointment and bring them with you to your appointment.
Important: Note that patients not seen in our office within the past 3 years are considered new patients.
- New Patient Packet - for new patients and those who we have not seen for 3 years or more.
- Existing Patient Update Form - for patients we have seen within the last 3 years.
Prescription refills are handled during regular office hours. Please allow 48 hours to process this request. Refills for certain medications such as nerve or pain medicines will be handled only by the physician prescribing them. Certain medications require close follow-up and an office visit may be necessary for medication refill or adjustment.
Insurance & Payment
We file insurance claims as a convenience to our patients when adequate insurance information is provided. However, you are responsible for your bill regardless of what the insurance company pays. Please bring your insurance card(s) to each office visit. For office visits and procedures, payment of any deductible, co-payment, or amount not covered by insurance, is expected at the time of service. Our billing staff is able to assist with special arrangements when necessary. For your convenience, we do accept VISA and MasterCard as well as cash and personal checks. We gladly accept Medicare and are providers for many HMO, PPO and POS plans.
If your insurance company requires a referral, please bring your referral with you at the time of appointment. Without a referral, you will be responsible for total payment of services provided. Please contact your Primary Care Physician or insurance company for inquiries about referrals.
Financial Responsibilities of the Patient
Thank you for choosing Southern Endoscopy Suite. There are some important terms to know if contacting your own insurance carrier for information regarding your benefits.
If you are checking your benefits with your insurance company please understand that we do not do colonoscopys, endoscopies or any other procedure in the office. These procedures are done at Southern Endoscopy Suite, LLC, our Ambulatory Surgical Center (ASC) Permit No. 067-200. Our facility is Medicare Certified and accredited with the Association for Ambulatory Health Care, Inc. (AAA). Southern Endoscopy Suite is located in the same building as our Lawrenceville clinic location. Procedures done in our Endoscopy Suite are NOT office procedures. They are procedures performed in an Outpatient Setting.
Our surgery scheduler will gladly assist you with contacting your insurance company to verify coverage and determine what your financial responsibility should be. Verification of benefits is not a guarantee of payment.
You can expect the following bills as a result of your procedure:
- Physician Fee: Fee to be paid to the physician for the performance of the service. This bill will be from Southern Gastroenterology Associates.
- Facility Fee: Fee to be paid for the use of the facility for your procedure. This fee covers the cost of facility staff, equipment, and supplies. This bill will be from Southern Endoscopy Suite, LLC.
- Anesthesia Fee: Fee to be paid for services from the anesthesia group for anesthetic, anesthesiologist services, vitals monitoring. This bill will be from SG Anesthesia, LLC.
- Pathology Fee: This fee is for any tissue biopsy and the processing of the biopsy. This bill will be from Caris Diagnostics.
The above will vary if having your procedure done in a hospital setting. Consult the hospital with questions.
Your insurance will send you an explanation of benefits that will explain how your bill was broken down and paid. It will also tell you the amount that remains your responsibility. The explanation of benefits (EOB) is NOT a bill. Do not pay from the EOB.
Each of the companies listed above will have a copy of the EOB and payment from your insurance. Once the payment has been processed you will receive a bill. If you have questions after receiving a BILL, please call our business office at 678-985-1994.
Special Note: A deposit will be requested prior to your procedure. We ask for a 72-hour notice of cancellation in order to better serve our patients in minimizing costs. A missed appointment or late cancellation will result in a $50.00 charge. This payment is the responsibility of the patient.