Knowing how you will pay for care should be simple. This page explains how payment works for visits and procedures with Dr. Michael Pimienta, a gastroenterologist (GI doctor) on Wilshire Boulevard who cares for adults across Los Angeles. If anything here is unclear, call us at (424) 281-7392 and our team will walk you through it.
How you can pay
There are three ways patients usually come to the practice. Find the one that fits you, then read the section below for details.
Medicare
Original Medicare is accepted, including patients who also have a secondary (supplemental) plan. We confirm your coverage before your visit.
Medicare Advantage
Medicare Advantage plans have their own rules and networks. Please call us before booking so we can check your plan.
Other insurance or no insurance
The practice is out of network with PPO and other commercial plans, so visits are self-pay. Our team explains the price first, and you get a superbill to send to your insurance.
We do not list prices on this website because the cost depends on the kind of visit or procedure you need. Our team will tell you the price before anything is booked.
If you have Medicare
Dr. Pimienta accepts Medicare. If you have Original Medicare (Part A and Part B), you do not need a referral to see a specialist like a gastroenterologist. Many people also have a secondary or supplemental plan, such as a Medigap policy, that helps pay what Medicare does not. Those patients are welcome too.
Under Medicare Part B, you usually pay a yearly deductible and then a share of the cost (coinsurance) for office visits. A supplemental plan may pay some or all of that share, depending on the plan. When you book, our team confirms your coverage and tells you what to expect.
Medicare Advantage plans work differently. These plans (sometimes called Part C) are run by private companies and often have their own networks and referral rules. Call us at (424) 281-7392 before booking so we can check your plan.
Medicare generally covers colorectal cancer screening, including screening colonoscopy, at set intervals. If a polyp is removed or a biopsy is taken during a screening colonoscopy, you may owe coinsurance. Our team explains this before your procedure. You can read Medicare's own description of coverage at Medicare.gov.
If you have other insurance or no insurance
For PPO plans, other commercial insurance, or if you do not have insurance, the practice is out of network. That means we do not bill your insurance company directly, and your visit is self-pay (you pay the practice yourself).
Here is how it works:
You ask for an appointment
Use the appointment request form or call the office. Choose "Other insurance or self-pay" so our team knows to explain pricing.
Our team calls you
We explain the price of your visit and how out-of-network benefits may work with your plan, before anything is booked. There is no obligation.
You pay before the visit
Payment is due before your appointment. Ask our team how you can pay.
You get a superbill
After your visit, you receive a superbill you can send to your insurance company to ask for out-of-network reimbursement.
Some people with high-deductible plans find that self-pay care is easier to plan for, because they know the price up front. Many people can also use health savings account (HSA) or flexible spending account (FSA) money for medical care. Check with your plan to see what it allows.
Using a superbill with your insurance
A superbill is a detailed receipt. It lists the services you received, the medical codes for your visit and diagnosis, Dr. Pimienta's information, and the amount you paid. Insurance companies use these details to decide whether to pay you back.
You submit the superbill yourself, usually with a claim form from your insurance company or through its website or app. Whether you are paid back, and how much, depends on your plan. It often depends on:
- Whether your plan has out-of-network benefits at all (many HMO and EPO plans do not, except for emergencies)
- Your out-of-network deductible, and how much of it you have already met this year
- The percentage your plan pays for out-of-network care, and the amount it allows for each service
- Deadlines for sending in a claim
Before your visit, call the number on your insurance card and ask: "Do I have out-of-network benefits for a specialist visit? What is my out-of-network deductible? What percentage do you pay back?" Write down the answers and the name of the person you spoke with.
We cannot promise that your insurance will pay you back, but our team is glad to explain how out-of-network benefits usually work.
Paying for a colonoscopy or upper endoscopy
Dr. Pimienta performs colonoscopy and upper endoscopy (EGD) at Specialty Surgical Center of Beverly Hills, less than a mile west of the office. A procedure usually involves more than one bill:
- Dr. Pimienta's fee for doing the procedure
- The surgery center's fee for the room, staff and equipment
- Anesthesia, for the medicine that keeps you comfortable (sedation)
- Pathology, if a polyp or tissue sample (biopsy) is sent to the lab
The surgery center, anesthesia and pathology may bill you separately. Our team explains what to expect before your procedure, so you are not surprised later. You can learn how to get ready on our procedure preparation page.
Payment and cancellation policies
- When to pay
- Before your visit
- Cancel or reschedule
- Please give at least 24 hours' notice
- Prices
- Explained by phone before booking
- Questions
- Call (424) 281-7392
If you need to cancel or move your appointment, please call at least 24 hours ahead. This lets us offer the time to another patient who needs care.
Your right to a Good Faith Estimate
Under federal law, if you do not have insurance or are not using insurance, you have the right to receive a Good Faith Estimate of the expected charges for your care when you schedule or when you ask for one. If your final bill is at least 400 dollars more than your estimate, you can dispute it. For more information, visit www.cms.gov/nosurprises.
Questions patients ask
Does Dr. Pimienta take my insurance?
Dr. Pimienta accepts Medicare, including patients with a secondary plan. For Medicare Advantage, call us first so we can check your plan. For other insurance, the practice is out of network, so visits are self-pay and you receive a superbill to send to your insurance.
Why aren't prices listed on the website?
The price depends on the type of visit or procedure you need. Our team calls you to explain the price for your situation before anything is booked.
Will my insurance pay me back for a self-pay visit?
It depends on your plan. Many PPO plans pay back part of the cost of out-of-network care after you meet a deductible. HMO and EPO plans often do not. Call your insurance company before your visit to ask about your out-of-network benefits.
Do I need a referral?
Not with Original Medicare. If you have a Medicare Advantage plan, call us before booking, because some plans have referral rules. Self-pay patients do not need a referral, though records from your other doctors are always helpful.
Will I get more than one bill for a colonoscopy?
Often, yes. The surgery center, anesthesia and pathology may bill separately from Dr. Pimienta. Our team explains what to expect before your procedure.
What if I need to cancel?
Please call the office at least 24 hours before your appointment to cancel or reschedule. That way another patient can use the time.