Gastroenterology Group Of Rochester
 
 
 

 

 

 

 

Positive SSL on a transparent background
Security Information

 






 

 

 

 

 

 

Enrollment Service for Gastroenterology Group Of Rochester HealthePay Program

Payment is due at the time of service. If a patient is unsure of their covered benefits, Gastroenterology Group Of Rochester will accommodate requests for a delay of payment until such time that Gastroenterology Group Of Rochester sends the claim to the insurance company and receives an explanation of benefits, and allows patient or guarantor up to 60 days to make payment so long as the patient or their guarantor, agrees to enroll in our HealthePay Program. The patient or their guarantor must provide a current credit card and agree to allow Gastroenterology Group Of Rochester to charge that card for all charges deemed to be the patient's responsibility. This includes payment in full for the visit if the insurance card information is invalid or not current.

All credit card information is kept on a secure server in compliance with Federal Privacy and Security Standards. By enrolling in this program, you agree to receive email confirmation of your enrollment in the Gastroenterology Group Of Rochester HealthePay Program. You also agree to an email confirmation when your credit card is charged. The information that may be sent will be the date of service and total fees due. There will be no diagnosis codes or visit details on that receipt but are available by request. This is to maintain your or your child's health information confidential.

By submitting the below information you are authorizing us to charge your credit card for future balances not paid by your insurance company.
(View User Agreement)

 Enrollment Form:

*
*
*
*
*
* Last Name
*
*
* 2-letter abbreviation
*
*
*

Please click only once