Frequently Asked Questions

General Surgery

Does Midlands Clinic perform the surgery that I need?

Our expert team of dedicated physicians offers a wide range of specialized, comprehensive services. What follows is a brief list of the surgeries that we offer. If you need a surgery that is not listed, please do not hesitate to contact us for more information.

  • Anal Surgery
  • Appendectomy
  • Weight Loss Surgery (Obesity)
  • Breast Cancer Surgery
  • Cancer Surgery
  • Cyst Removal
  • Gallbladder
  • Hemorrhoid Surgery
  • Hernia Repair
  • Intestine/Colon Surgery
  • Lap-Band
  • Laparoendoscopic Single-Site Surgery
  • Laparoscopic Gastric Bypass
  • Port Placements
  • Skin Grafts
  • Stomach Surgery/GERD
  • Varicose Vein Stripping
  • Vein Injections
  • Veins

How should I prepare for my surgery?

For our instructions on preparing for surgery, please click here.

How is a Gastric Sleeve or Gastric Bypass surgery performed?

  1. 5-6 small incisions are created on the abdomen.
  2. Trocars are placed in those incisions and the surgical instruments are passed through the trocars to access the abdominal cavity.
  3. The surgeon uses a laparoscope (video camera) to examine the abdominal cavity, checking that there are no obvious anatomical abnormalities present.
  4. A small stomach pouch is created using a device that cuts and staples at the same time.
  5. The small intestine is separated into two sections.
  6. The lower portion of the small intestine is attached to the newly created stomach pouch.
  7. The upper portion of the small intestine is re-attached to the lower portion of the small intestine.
  8. The incisions on the skin of the abdomen are closed with surgical glue rather than staples or sutures.


How many charges can I expect to receive from my colonoscopy?

You will always receive at least two charges…one charge from your Doctor at Midlands Clinic and the other for the use of the facility or hospital. If anesthesia is given during the colonoscopy, you could receive a charge for the Anesthesiologist as well.  Additionally, if clinical findings necessitate a biopsy, then you will receive a charge for the Pathology Laboratory’s services. Thus, you could receive as many as 4 different bills for your colonoscopy.

Will my colonoscopy be considered screening, surveillance or diagnostic?

Colonoscopy patients fall into 3 different categories and strict coding guidelines are used to determine under which category you may fall. These guidelines may preclude your procedure being covered at 100% by your insurance carrier even though your primary care physician may have referred you for a “screening” colonoscopy. A personal or family history may be the basis for your procedure to be considered either a diagnostic or surveillance colonoscopy as determined by each individual health insurance carrier policy.

1. Diagnostic / Therapeutic Colonoscopy – Patient has gastrointestinal symptoms (ex. blood in stool, changes in bowel habits, hemorrhoids), colon polyps, or gastrointestinal disease requiring evaluation or treatment by colonoscopy.

 2. Surveillance / High Risk Colonoscopy Screening – Patient is asymptomatic (no present gastrointestinal symptoms) and has a personal history of Crohn’s Disease, Ulcerative Colitis, or a personal or direct relative with colon polyps, and/or colon cancer. Patients in this category are required to undergo colonoscopy surveillance at shortened intervals (usually every 2 – 5 years) and depending on your insurance carrier, this category may be reimbursed as if you were having a diagnostic colonoscopy.

3. Preventive / Average Risk Colonoscopy Screening (Included as part of the Affordable Care Act) – Patient is asymptomatic (no present gastrointestinal symptoms), is 50 years old or older and has no personal history of gastrointestinal disease, colon polyps, and/or cancer. Patients in this category have not undergone a colonoscopy within the last 10 years.

What are the risks associated with undergoing an endoscopic procedure?

Endoscopies are generally safe when performed by physicians with specialized training and experience.  In rare circumstances, a perforation of the digestive tract may occur, which could possibly require surgery to repair.  Minor bleeding may occur at the site of a polypectomy, but this typically stops on its own or may be controlled by the endoscopist.  There could be adverse reaction to the sedatives given for the procedure, but this too is rare.

Severe abdominal pain, fever or rectal bleeding should be reported to the endoscopist during the post-procedure recovery period, or if they are experienced within a couple days following an endoscopic procedure.

What kind of preparation is necessary for an endoscopy?

The preparation varies depending on your health history and the procedure planned.  For endoscopic examination of the upper digestive tract, food and fluids are withheld for several hours before the procedure.  For endoscopic examinations of the colon, a special diet needs to be followed for several days in addition to the need for a thorough bowel prep to cleanse your colon prior to the procedure.  There may be variations to these preparations, depending on your condition. It is very important to follow your instructions carefully, as an incomplete preparation may require an additional appointment. Please consult our office if you have any questions about your preparation.  A full preparation is necessary, as a partial prep will likely result in an additional appointment.

My doctor is treating me for GERD? Will I need an upper GI endoscopy?

GERD, gastroesophageal reflux disease, is caused when stomach acid travels back up into the esophagus.  The symptoms of GERD are frequent heartburn, difficulty swallowing, regurgitation of food and fluids, chest pain and asthma.  Normally, there is a valve (LES) at the lower portion of your esophagus that opens when you swallow but remains closed at all other times.   This valve usually prevents reflux.  Malfunction of this valve causes reflux.  GERD may be controlled with lifestyle and diet changes.  Not all heartburn is GERD, but longstanding heartburn, especially if uncontrolled with over the counter medications, weight control and lifestyle changes, may require evaluation by gastroenterologist.

One of my parents had colon cancer. Am I at risk?

Your primary care physician may want to reduce any risk of cancer by ordering a baseline colonoscopy before the age of 50. This procedure is identical to a screening or routine colonoscopy in that the inner lining of the colon is examined and any polyps are biopsied and may be removed.  Specific risk due to familial circumstances should be discussed at length with your primary care physician, or Gastroenterologist.

Will I be uncomfortable during my procedure?

During an endoscopic procedure, the patient is consciously sedated using a combination of drugs.  An Anesthesiologist is not necessary for routine colonoscopies or EGDs (upper GI endoscopies).  The patient may or may not be awake during the course of the procedure, and frequently upon recovery the patient has no memory of what happened during their procedure.  Common sensations are bloating, pressure and cramping as the colon is expanded with air as the endoscope is passed through the colon.  However, with the use of an Anesthesiologist, patients usually are sedated throughout the entire procedure and therefore have fewer symptoms.

What is a polyp? Are they normal?

Polyps are considered to be an abnormal growth in the lining of the digestive tract.  They are usually benign, but vary in size and structure. Cancer may begin in polyps, so their removal is necessary to allow pathologists to determine their specific risk.

What is a screening colonoscopy?

All adults should undergo colon cancer screening beginning at age 50 or earlier, depending upon the risk of developing colorectal cancer. Several tests are currently available, each of which has advantages and disadvantages. The optimal screening test is a screening colonoscopy. A screening colonoscopy is a commonly ordered health screening examination of the colon. The patient is given a mild sedative drug before the procedure. During a colonoscopy, a thin lighted tube is inserted through the rectum allowing the gastroenterologist  a full view of the lining of the rectum and the entire colon.  If polyps are discovered, they may be removed as part of the procedure.


What dermatology services does Midlands offer?

Midlands Clinic offers a wide range of dermatology services, including, but not limited to, the following:

  • Acne/Rosacea
  • Hyperhidrosis/Botox Therapy
  • Melasma
  • Moles
  • Dry Skin/Eczema
  • Psoriasis
  • Skin Cancer
  • Basal Cell
  • Squamous Cell
  • Melanoma
  • Mohs Surgery
  • Warts/Molluscum
  • Wound Care Instructions

For more information, or to set up a consultation with a member of our dedicated Dermatology team, call 605-217-5500, or contact us online.

How much are cosmetic treatments?

For a full list of our cosmetic services and pricing, click here. 

Miscellaneous FAQ

Do I need a referral to receive services?

  • Dermatology – You do not need a referral unless your insurance carrier requires one.
  • General Surgery – Most often, you will be referred to the general surgeon by another physician. Under special circumstances, however, our surgeons will see you if you do not have a physician referral.
  • Gastroenterology – Most often, you will be referred to the gastroenterologist by another physician. Under special circumstances, however, our gastroenterologists will see you if you do not have a physician referral.

Can the physician change, add, or delete my diagnosis so that my procedure can be considered a preventive screening?

NO. The patient encounter is documented utilizing the information you have provided and the results of your Provider’s evaluation and assessment. Once the medical record is documented it becomes a binding legal document and it cannot be changed to facilitate better insurance coverage.

Does Midlands Clinic Participate with my insurance carrier?

It is always best to contact your insurance carrier prior to your appointment and ask them is our physician is in their network.

For more information, please view the Billing and Insurance section of our New Patients page.