Insurance and Financial Information
Northwest Gastroenterology Clinic accepts the health insurance networks listed here. If you have a health plan that is not listed, please call our billing department to get benefit information. For out-of-network information, please call your insurance carrier. If you do not have health insurance benefits a deposit will be required for all office visits and procedures performed at NGC Endoscopy Services. Please call 503-229-7461 to speak with a billing representative.
Payment at Time of Service
It is your responsibility as our patient to provide accurate and current information at the time of service so that we may bill your insurance. We require a copy of your insurance card at the time of each visit. If you are unable to provide your card before seeing the provider, the visit may be considered fee for services and full payment may be collected. If your insurance requires a co-payment, deductible or co-insurance, it will be collected during your visit.
You may receive up to four separate statements for the services related to your procedure. These include the physician services fee, the facility fee, fees for pathology services and the anesthesiologist services fee.
You can read a full copy of our financial policy here
If you have questions about your bill, please call our dedicated billing line, 503-229-7461.
NOTE: Your insurance coverage is an agreement between you and your insurance company. Financial responsibility rests with the patient for deductibles, co-insurance and non-covered services. We accept Visa, Mastercard, Discover and American Express. You can also make a payment via my portal
Good Faith Estimate and No Surprise Billing Law
You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.
Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coveragean estimate of their bill for health care items and services before those items or services are provided.
- You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the healthcare provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
- If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate and the bill.
For questions or more information about your right to Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.
PRIVACY ACT STATEMENT: CMS is authorized to collect the information on this form and any supporting documentation under section 2799B-7 of the Public Health Service Act, as added by section 112 of the No Surprises Act, title I of Division BB of the Consolidated Appropriations Act, 2021 (Pub. L. 116-260). We need the information on the form to process your request to initiate a payment dispute, verify the eligibility of your dispute for the PPDR process, and to determine whether any conflict of interest exists with the independent dispute resolution entity selected to decide your dispute. The information may also be used to: (1) support a decision on your dispute; (2) support the ongoing operation and oversight of the PPDR program; (3) evaluate selected IDR entity’s compliance with program rules. Providing the requested information is voluntary. But failing to provide it may delay or prevent processing of your dispute, or it could cause your dispute to be decided in favor of the provider or facility.
Your Rights and Protections Against Surprise Medical Bills
Español –Sus derechos y protecciones contra facturas médicas sorpresa