Microsoft word - capsule endoscopy _2_
A Division of Wake Internal Medicine Consultants, Inc.
Charles F. Barish, MD
Bulent Ender, MD
Seth A. Kaplan, MD
Marc A. Herschelman, DO
Endoscopy Scheduling: Ext: 1281- Ann or Ext: 1278- Vikki
Your Capsule Endoscopy
is scheduled for _____________________________ (date) at _____________
(time). Please be here at __________________ (15 minutes prior to your scheduled procedure).
The day before the procedure, eat a normal diet until 12 Noon. From 12 Noon until 8 p.m., you may have clear liquids only. NO RED JELL-O
Carafate, Mylanta, or Maalox for 24 hours prior to the procedure.
Drink ½ bottle of Half-Lytley at 7 p.m. the night before. (you will be given a prescription for this)
Starting 12 hours before procedure absolutely NOTHING to eat or drink.
NO Medications 12 hours before procedure.
TAKE 2 PHAZYME TABLETS BEFORE YOU LEAVE HOME THE DAY OF YOUR APPOINTMENT.
NO Iron supplements 4 days before procedure.
Dress comfortably and wear two-piece clothing.
You may take your medications after your procedure.
You will need to return at 4:15 p.m. to return the capsule Endoscopy equipment. We will download the images for a physician to review.
Please be aware that you should not have a MRI or be near a MRI device until after
having passed the camera capsule through a bowel movement.
ALL COLONOSCOPY-SIGMOIDOSCOPY-GASTROCOPY PATIENTS
PRIOR INSURANCE APPROVAL
Some insurance companies require prior approval for these procedures done in the office. It is your responsibility to check with your insurance company for prior approval. If they require authorization, please call our office, (919) 781-7500 ext 281, with all pertinent information and we will obtain the authorization. Some insurance companies may not cover screening procedures. If your doctor has requested your procedure because you have reached the age where these procedures are recommended, you insurance company considers this a screening procedure. It is your responsibility to see how your insurance company will cover the procedure. For some outpatient procedures, insurance companies will cover at a percentage or copay different than they would for an office visit.
WAKE INTERNAL MEDICINE PAYMENT POLICY
PAYMENT IS DUE AT THE TIME OF SERVICE
Wake Internal Medicine Consultants does require patients with Medicare and noncontracted insurances
to pay to pay your estimated cost of the procedure in full one week prior to services being rendered. This
is an estimated cost only and is subject to change in response to the physician’s findings and subsequent
If you have Medicare your estimated cost will be based upon the current Medicare Limiting Allowable, for all
other plans your estimated cost will be based upon our current fee schedule. Our office will submit a claim to
your insurance company on your behalf. Your insurance company will then remit their payment directly to you,
If you have insurance that is deductible, coinsurance, or copay the patient will be responsible to pay the full
amount prior to services being rendered. For example; if BCBS State is your insurance and have not met your
deductible of $350.00 you will be expected to pay up to $350.00. If you have met your deductible you will be
asked to pay a $150.00 down payment that is to offset the 20% patient coinsurance.
We thank you for your patience and cooperation through the billing process and greatly appreciate you
choosing Wake Internal Medicine for your medical care. If you have any questions regarding your fees please
call (919) 781-7500 ext 324. ALL COLONOSCOPY – UPPER ENDOSCOPY PATIENTS
Because of the medication you receive, you may not remember the procedure or speaking with the doctor
afterwards. We encourage you to ask questions prior to the procedure and to call our office afterward, should
you have any questions. The doctor will discuss his findings with you after the procedure. If biopsies or polyps
were removed during the procedure, you should receive a phone call regarding the findings within 5-7 business
days. If you have not heard from our office about the pathology results within 7-10 business days, please call.
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