Patient Forms

Patient Info Packet

Insurance & Billing Information

Collections and Payment Policy

Be prepared to pay any deductible, co-pay, and/or co-insurance amounts on the day of your appointment. This facility accepts cash, cashier’s checks, Visa/MasterCard/Debit, and personal checks with a valid I.D.

Insurance

We will bill your primary and secondary insurance carriers or governmental agency directly for the facility’s fees. Be sure to bring your most current insurance card(s) with you on the day of your surgery. If you have more than one insurance carrier, we will also need accurate secondary billing information. Please be aware of any admission policies your insurance plan may have. You or your physician may have to adhere to certain requirements in order to insure maximum reimbursement. Failure to obtain pre-authorization, physician referral, or a second opinion may greatly reduce or eliminate your benefits.

Medicare

Medicare beneficiaries are welcome to receive services at this facility. This facility is certified by Medicare and complies with specified physical plant, staffing, safety and governance standards. Taken from the Medicare & You Handbook for Part B-Covered Services. Facility fees for approved services at an Ambulatory Surgery Center – you pay 20% of the Medicare approved amounts and any applicable Part B deductible.

For more information on Medicare and your benefits, please visit www.medicare.gov.

If you have questions regarding your payments, insurance or other financial issues, please see Contact Us