BILLING AND INSURANCE

Out of Network or Uninsured Patients - Billing Information

Dr. Cohen has opted out of Medicare and is out of network for Blue Cross Blue Shield but continues to see Medicare, BCBS, other out of network patients, and uninsured patients with the following discounted fee schedule, which in many cases results in costs similar to what your copay/coinsurance would be for an in-network doctor:

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In total, the amount of your payment combined with your insurance company’s payment should not exceed the dollar amounts listed below. For example, if you have had an Upper Endoscopy and your insurance has reimbursed the practice $300, you would owe $100. Since we are opted out of Medicare and Blue Cross, for patients insured by those payors the full amounts below will be due at the time of the visit, but in some cases Blue Cross will reimburse you some of that cost. We will file the Blue Cross insurance claim on your behalf.

 

New patient office consult             $350

Return patient office visit               $250

Upper Endoscopy                           $400

Colonoscopy                                   $700

Flexible Sigmoidoscopy                 $350

Hemorrhoid banding (per band)    $350

 

Due to the complexities of medical billing, occasionally you may receive a bill for more than these amounts. If you contact our billing company at 707-255-7995, they can adjust the final balance of the bill if necessary.

 

One final note: for endoscopic procedures (Upper Endoscopy, Colonoscopy, and Flexible Sigmoidoscopy), you will get a bill from this practice and a bill from the hospital for their facility fee. The above dollar amounts apply only to the bill from this practice. The hospital fee is typically covered as an in-network expense, but we always recommend that you check your hospital coverage by calling your insurance company, speak with a person, and make note of that person’s name as well as the reference number for the phone call. The best information about your hospital coverage will come from your insurance company. However, sometimes even they will give you incorrect information so it helps to save a record of the call. If the hospital is out of network or not covered, for further information about the hospital’s billing policies and procedures please contact the Northwestern Medicine billing department at 312-926-6900.

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Here are some identification numbers you may need to check your hospital coverage:

• NORTHWESTERN MEMORIAL HOSPITAL: NPI: 1497859649; Address: 259 E Erie St

• Upper Endoscopy CPT Codes: 43235 or 43239

• Colonoscopy CPT Codes: 45378 or 45380 or 45385

• Flexible Sigmoidoscopy CPT Codes: 45330 or 45331 or 45338

 

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In Network Patients - Billing Information

 

For in network patients we always recommend that you check your coverage by calling your insurance company, speak with a person, and make note of that person’s name as well as the reference number for the phone call. The best information about your coverage will come from your insurance company. However, sometimes even they will give you incorrect information so it helps to save a record of the call.

For endoscopic procedures (Upper Endoscopy, Colonoscopy, and Flexible Sigmoidoscopy), ask if a pre-AUTHORIZATION, pre-DETERMINATION, pre-NOTIFICATION, pre-APPROVAL or REFERRAL is required for coverage and notify our office immediately if the answer is YES. Check whether Northwestern Memorial Hospital is covered in network, out of network, or not at all. If the hospital is out of network or not covered, for further information about their billing policies please contact the Northwestern Medicine billing department at 312-926-6900.

Here are some identification numbers you may need:

• NORTHWESTERN MEMORIAL HOSPITAL: NPI: 1497859649; Address: 259 E Erie St

• GREG COHEN MD: NPI: 1669447348; Address: 676 N Saint Clair St; Old Address: 201 E Huron St

• Upper Endoscopy CPT Codes: 43235 or 43239

• Colonoscopy CPT Codes: 45378 or 45380 or 45385

• Flexible Sigmoidoscopy CPT Codes: 45330 or 45331 or 45338

 

Insurance Accepted (last updated 2/22/2024)

● Aetna ● Cigna ● The Alliance ● Corvel ● Humana Military ● Humana Commercial (Non DeKalb County) ● Imagine Health ● Multiplan ● United Healthcare (including Core and Navigate) ● Zelis

If your insurance is not listed above, consider calling the customer service number on your insurance card to see if Dr. Cohen is in your network.  Many insurance companies belong to Insurance Consortiums that are not always clearly identified by name, however Dr. Cohen may participate in the Provider Network.

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For billing questions click here

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To pay an outstanding balance click here

Note: This link works best from a desktop computer.

From a mobile device, you will be prompted to download the Paypaya payment app.

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