Paying Your Bill

Your anesthesia provider will determine an appropriate anesthesia plan based on your procedure and health history and will discuss the plan with you on the day of surgery.

Monitored Anesthesia Care (MAC) / IV Sedation
Medication is administered through an IV to make you relaxed and comfortable during your procedure. Depending on the procedure and level of sedation required, you may remember little or nothing about the surgery.

Regional Anesthesia / Nerve Block
For certain foot and ankle procedures, a local anesthetic may be placed near specific nerves to temporarily numb the foot, ankle or lower leg. A nerve block may be used together with sedation or general anesthesia and may also provide pain relief following surgery.

General Anesthesia

For some procedures, general anesthesia may be appropriate. Medications are administered to keep you fully unconscious during surgery while your anesthesia provider continuously monitors and manages your vital functions.

If you have questions or concerns, please discuss them with your anesthesia professional before the procedure.

Below are policies specific to Capital Anesthesia Partners that must be followed for all procedures conducted by our practice:

Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists

• Effective Date:  September 14, 2023
• Summary: 7 full day hold (as defined below)

All patients taking GLP-1 Receptor Agonists are required to stop these medications at least 7 full days prior to receiving anesthesia services at CAP affiliated sites. E.g. If a procedure is scheduled on a Monday, the medication should be last taken on the previous Sunday, as this would allow seven full days (Mon, Tue, Wed, Thu, Fri, Sat, and Sun) off the medication, not including the day of the procedure.

Patients that do not hold these medications will have their procedure cancelled.

Common examples of GLP-1 medications include, but are not limited to:

• semaglutide - marketed as Wegovy, Ozempic, and Rybelsus
• liraglutide - marketed as Saxenda and Victoza
• dulaglutide - marketed as Trulicity
• exenatide - marketed as Byetta and Bydureon
• lixisenatide - marketed as Adlyxin
• tirzepatide - marketed as Mounjaro and Zepbound

SGLT2 Inhibitor Medications

• Effective Date:  October 1, 2025
• Summary: 3 full day hold (as defined below)

All patients taking SGLT2 Inhibitors are required to stop these medications three full days immediately before the day of procedure.  E.g. If a procedure is scheduled on a Monday, the medication should be last taken on the Thursday before, as this would allow three full days (Fri, Sat and Sun) off the medication, not including the day of the procedure.

Patients that do not hold these medications will not receive anesthesia.  This policy does allow cases to proceed without anesthesia by physician/ASC decision, but anesthesia will not sedate and will not be present to record vital signs.

Other medications and supplements

Please refer any questions related to other medications or supplements to your physician in advance of your procedure.  Do not discontinue diabetes treatment without coordinating with your prescribing physician and surgeon/proceduralist.

Capital Anesthesia Partners must submit claims that accurately reflect the procedure performed, the diagnosis information supplied for the encounter, the anesthesia documentation, and applicable coding requirements. We cannot change a CPT code, diagnosis code, or modifier solely to obtain a different insurance-coverage or payment result. 

If you believe information on your claim is incorrect, please contact our billing office at 1-877-222-4217. We will review the claim and correct any confirmed error. Questions about how your plan processed an accurately coded claim should be directed to your insurance carrier.

Knowing the difference between a screening and diagnostic colonoscopy can help you better understand your insurance coverage and potential out-of-pocket costs.

A screening colonoscopy is a preventive procedure performed on patients without symptoms to detect colorectal cancer or precancerous polyps. Under the Affordable Care Act (ACA), most private insurers are required to cover recommended preventive services (like screening colonoscopies) at no cost to the patient, meaning no co-pays or deductibles in many cases.

A diagnostic colonoscopy is performed to evaluate symptoms or specific clinical concerns, such as:

• Rectal bleeding
• Abdominal pain
• Diarrhea
• Iron deficiency anemia

Because this type of procedure is not considered preventive, deductibles, coinsurance, or copayments may apply based on your insurance plan.

A colonoscopy performed because of a personal history of polyps is often described as a surveillance colonoscopy. Depending on the clinical circumstances and your insurance plan, it may be processed as preventive, surveillance, or diagnostic and may be subject to cost-sharing.

Coverage rules vary among commercial plans, Medicare, Medicaid, and other payers. Before your procedure, ask your insurer how it classifies surveillance colonoscopy and whether anesthesia, polyp removal, and pathology are subject to a deductible, copayment, or coinsurance.

A colonoscopy may be scheduled for screening, surveillance, or diagnostic reasons. How the procedure and anesthesia are covered depends on the reason for the examination, applicable preventive-service requirements, the services performed, and the terms of your health plan.

·  For many non-grandfathered commercial health plans subject to Affordable Care Act preventive-services requirements, a qualifying colorectal cancer screening colonoscopy - including medically appropriate anesthesia, removal of a polyp, and related pathology - is covered without patient cost-sharing when furnished as part of the preventive screening.

·  A follow-up colonoscopy after a positive qualifying stool-based screening test or other covered non-invasive colorectal cancer screening test is generally considered part of the screening process for plans subject to those federal requirements.

·  A colonoscopy performed because of symptoms, an abnormal finding outside a qualifying screening pathway, or another diagnostic indication may be subject to your plan’s deductible, copayment, or coinsurance.

·  Medicare and other plans may apply different coding and cost-sharing rules. Coverage also may differ for grandfathered plans, short-term coverage, and other plans not subject to the same preventive-service requirements.

Federal law is phasing out Medicare Part B coinsurance when a colorectal cancer screening colonoscopy results in removal of a polyp or another procedure that causes the service to be treated as diagnostic or therapeutic for Medicare billing purposes.

For these Medicare services, beneficiary coinsurance is:

• 15% during 2023-2026
• 10% during 2027-2029, and
• 0% beginning in 2030

The Medicare Part B deductible is waived.  Your actual responsibility depends on the services billed, Medicare’s rules, any supplemental coverage, and other applicable benefits.

Anesthesia services provided during an esophagogastroduodenoscopy (EGD) (also known as upper endoscopy) are not considered preventive under the Affordable Care Act (ACA). As a result, these services are typically not covered at 100%, and patients may have financial responsibility based on their individual insurance plan including unmet deductible, coinsurance and/or copayment.

If you would like an estimate of your anesthesia costs prior to your procedure, please contact our corporate office. Our team will be happy to assist you in understanding your expected financial responsibility.

When a colonoscopy and upper endoscopy (EGD) are performed during the same anesthesia encounter, coverage and patient cost-sharing may depend on the reason for each procedure, the anesthesia code and modifiers reported, and the terms of your health plan.

The addition of an EGD does not create one universal coverage result for every patient or payer. Even when the colonoscopy is preventive, the EGD or other services may be subject to deductible, copayment, or coinsurance. Contact your insurer before the procedure and ask how anesthesia for the combined encounter will be covered.

Capital Anesthesia Partners provides anesthesia services for patients undergoing foot and ankle procedures at select ambulatory surgery centers. Our goal is to provide safe, comfortable anesthesia care while helping you recover and return home as quickly as appropriate following your procedure.

Your anesthesia will be administered and monitored by a qualified anesthesia professional. Before your procedure, your anesthesia provider will review your medical history, medications, allergies and previous experiences with anesthesia. You will also have an opportunity to ask questions about your anesthesia plan.

Unlike certain preventive healthcare services, podiatry and foot surgery anesthesia is generally subject to your plan's normal surgical and anesthesia benefits. Therefore, even when Capital Anesthesia Partners is an in-network provider, you may have an out-of-pocket responsibility depending on your insurance coverage and whether you have met your annual deductible.

If you have questions about your specific benefits, we recommend contacting your insurance carrier before your procedure.