Thank you for choosing us as your surgical care facility. Our goal is to provide you with the highest quality surgical care at an affordable cost. To make our services available to as many patients as possible on an affordable basis, we have adopted the financial policy outlined below. We ask you to read the policy carefully before signing any documents.
We may accept any assignable insurance with applicable coverage. We offer financial assistance (discount, waiver or reduction of deductibles, co-pays, or co-insurance) to all eligible patients on a case-by-case basis.
Full payment is due at time of service, unless arranged otherwise. We accept checks, cash, or credit cards (Visa®, Mastercard®, Discover®, American Express®). Dishonored checks will be charged back to the patient's account with a service fee of $35.00. Dishonored checks not redeemed within 30 working days of written notice to the maker will be referred for collection.
We may accept assignment of insurance benefits at our discretion if acceptable insurance identification is provided. Acceptable insurance identification is defined as a valid insurance card, policy/plan with applicable coverage, or telephone verification. As a courtesy to our patients, Lake Surgery & Endoscopy Center and Endosurg Outpatient Center will bill verifiable and assignable insurance. However, you will be personally responsible for your account balance whether or not your insurance will pay for the total balance of your claims, unless you are eligible for discounts before the services are rendered. Your insurance policy/employee benefits plan is a contract between you and your insurance company/employee benefits plan. We are not a party to that contract. In the event we do not accept assignment of benefits, we require that full payment prior to services being rendered is made by providing a credit card, check, or cash to pay for the balance due if your insurance company/employee benefits plan has not paid your account in full within 90 days or has determined your claims to be your responsibility for reasons including but not limited to annual deductible, co-payment, noncovered services, ineffective coverage at the time of services, lack of pre-authorization, and not medically necessary.
We will disclose to every patient our facility charges as clearly as practically possible before your procedure(s) if it is known to us. Please feel free to ask our staff if you have any questions about charges and your payment responsibilities.
As you may be aware, your insurance company requires your doctors to charge and bill their services separately from surgical facilities and hospitals. Therefore, you may receive separate bills from your treating doctor, anesthesiologist, pathologist, and others in addition to the surgical facility bills for your procedure. If you have any questions about your surgical facility bills, please direct them to us by contacting (352) 326-6518.
We do not anticipate that you will require additional medical or surgical care in connection with the procedure(s) that you are requesting. Nonetheless, should you require additional medical or surgical care in the unlikely event of post-surgical complications and reactions, you may incur additional expenses at this facility or outside this facility (e.g., hospital expenses). The charges only include the stated date of services at this facility and do not include any other date of service from us or other providers and facilities.
PPO and HMO Network Participation
As you may know, you may have a choice to choose a surgeon or surgical facilities with or without PPO or HMO participation under different insurance coverage and benefits levels. We are dedicated to providing the highest quality care to every patient; however, we have no power to change your insurance coverage or network limitations. Most healthcare plans, or insurance policies may provide surgical coverage to non-PPO providers and facilities, but at a lower percentage of insurance reimbursement. Although it is your responsibility to verify your insurance coverage for non-PPO/HMO providers, we will always disclose to you our participation status with your insurance plan.
As a courtesy to you, prior to your procedure we will verify your insurance coverage and obtain pre-certification, if applicable, for all services. Please understand that your insurance carrier may take the position that insurance verification is not a guarantee of insurance payment.
Your Responsibility for Cooperation
If we accept your insurance assignment as a payment from your insurance reimbursement, you agree to timely cooperate with your insurance company or health plan in the course of insurance claims processing, such as insurance inquiries, requests for additional information, claims, status verification, or any inquiries for the purpose of your claims processing. You also agree to notify us immediately of any insurance inquiry or request for additional information and will provide us with a copy of any documentation received from the insurance company or submitted to the insurance company from you.
In the event that you receive insurance payment check(s) for procedures rendered at Lake Surgery & Endoscopy and Endosurg Outpatient Center, you agree to submit such insurance reimbursement check(s) to our facility within 5 business days after your receipt of insurance check(s). In the event of a failure or refusal to forward or send us the insurance reimbursement check for the treatments from this provider, all your discount arrangement will be voided, and your total balance is due immediately, as there is no justification for you to keep the insurance payment for our services, as you promised to pay for our services.
We may offer medical discounts to uninsured (CashPay) and under-insured patients. We may also waive your cost-sharing amounts, deductibles, co-insurance, and co-pay based on your individual medical needs and ability to pay, on a case-by-case, nonroutine, unadvertised basis for under-insured patients, and after determining in good faith that you are in financial need. Unless expressly prohibited by any specific terms of the health plan, we are fully in compliance with the terms of the health plan and applicable federal and state laws. We are committed to serving you with the highest quality care possible at an affordable cost.
If you have any questions related to financial obligations (billing, financial assistance, payment plans, charity care (discounts) and/or collection procedures), please feel free to contact our billing department at (352) 326-6518.