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1. Delta Gastroenterology – Physician Charge
2. Delta Endoscopy Center – Facility Charge
3. SOMS Anesthesia – Anesthesia Charge
4. Delta Gastroenterology – Pathology Charge (if a biopsy is taken)
5. APS (Advanced Pathology Solutions) – Pathology Charge (if a biopsy is taken)
6. Self –Pay Pathology Fee 45.00 per biopsy
*PLEASE CONTACT YOUR INSURANCE TO ENSURE WE ARE IN YOUR NETWORK *

These payments are due at the time of services rendered. If you are unable to meet the financial terms, and other arrangements have not been made prior to your scheduled appointment date, you will be asked to reschedule your appointment. Medicare patients are responsible for 20% if there is no secondary insurance carrier. For commercial insurance accounts, payment is expected from you or your insurance carrier within 30 days from the date of service.  We accept Cash, Visa, Mastercard, American Express, Discover and Care Credit. Please contact our billing office at 662-280-8222 regarding Care Credit.

These payments are due at the time of services rendered unless other arrangements have been approved. If paying with

• Payment: Two separate payments will be needed. $600.00 will be issued to Delta Endoscopy Center for the Facility fee and $250.00 made out to SOMS Anesthesia.
• Credit Card: Your credit card will be ran twice. Once for Delta Endoscopy Center for $600 and once for SOMS Anesthesia for      $250.00.
• If a biopsy it taken, Pathology charges will apply from Delta Gastroenterology and GI Pathology. Please call Billing for more information on potential costs and information. These charges are not included in the $850.00 payment and are separate charges incurred. As a courtesy to you, we offer payment plans for these charges.

If you do not receive an explanation of benefits from your insurance carrier within 30 days, it is your responsibility to begin payment. Also, you will need to contact your insurance carrier for the exact status of all the charges and to provide this office with the current information. Accounts are considered delinquent when there is no payment activity every 30 days and will be reviewed for collection processing.

Thank you for choosing Delta Gastroenterology and Endoscopy CenterPCas your health care provider. We are committed to building a successful physician-patient relationship with you. Your clear understanding of our Patient Financial Policy is important to our professional relationship. Please understand that payment for services is a part of that relationship. Please ask if you have any questions about our fees, our policies, or your responsibilities. It is your responsibility to notify our office of any patient information changes (i.e. address, name, insurance information, etc.).

The patient is expected to present an insurance card at each visit. All co-payments and past due balances are due at time of check-in unless previous arrangements have been made with a billing coordinator. We accept Cash, Visa, Mastercard, American express, Discover or Care Credit.  Please contact our billing department at 662-280-8222 to discuss Care Credit.

If you have negotiated a payment plan with us, you are responsible for making timely and consistent monthly payments.  We offer payment plans as a courtesy to our patients in time of need. If you fail to keep your scheduled due date, your account will be sent to collections for non-payment.  Please contact our billing department to set up a payment plan 662-280-8222.

Insurance is a contract between you and your insurance company.  We will bill your primary insurance company as a courtesy to you. In order to properly bill your insurance company, we require that you disclose all insurance information including primary and secondary insurance as well as, any change of insurance information. Failure to provide complete insurance information may result in patient responsibility for the entire bill. Although we may estimate what your insurance company may pay, it is the insurance company that makes the final determination of your eligibility and benefits. If your insurance company is not contracted with us, you agree to pay any portion of the charges not covered by insurance, including but not limited to those charges above the usual and customary allowance. If we are out of network for your insurance company and your insurance pays you directly, you are responsible for payment and agree to forward the payment to us immediately.

Certain health insurances (HMO,POS, etc.) require that you obtain a referral or prior authorization from your Primary Care Provider (PCP) before visiting a specialist.  If your insurance company requires a referral and/or preauthorization, you are responsible for obtaining it. Failure to obtain the referral and/or preauthorization may result in a lower or no payment from the insurance company, and the balance will be your responsibility.  Alternative payment arrangements or rescheduling of your appointment may be necessary if not obtained.

Self-pay accounts are patients without insurance coverage, patients covered by insurance plans in which our practice does not participate, or patients without an insurance card on file with us.  It is always the patients’ responsibility to know if our office is participating with their plan.  If there is a discrepancy with our information, the patient will be considered self-pay unless otherwise proven.

Self-pay patients will be required to pay $225.00 at the initial appointment. Established patient appointments will be required to pay $125.00.  Payment arrangements are available if needed.  Please ask to speak with a billing specialist to discuss a mutually agreeable payment plan.  It is never our intention to cause hardship to our patients, only to provide them with the best care possible and the lease amount of stress

It is our office policy that all past due accounts be sent two statements. If payment is not made on the account, a single phone call will be made to try to make payment arrangements. If no resolution can be made, the account will be sent to the collection agency, or attorney, and possible discharge from the practice.  In the event an account is sent to collections, the person financially responsible for the account will be responsible for all collection costs including attorney fees and court courts.

Regardless of any personal arrangements that a patient might have outside of our office, if you are over 18 years of age and receiving treatment, you are ultimately responsible for payment of the service. Our office will not bill any other personal party.

This financial policy helps the office provide quality care to our valued patients. If you have any questions or need clarification of any of the above policies, please feel free to speak with the billing office.


DELTA GASTROENTEROLOGY AND ENDOSCOPY CENTER P.C.  RESERVES THE RIGHT TO CHANGE AND/OR MODIFY THIS INFORMATION AT ANY TIME.