There are a few things you can do when preparing for outpatient surgery at Aestique Surgical Center. You may have already received your surgical packet from your doctor’s office. The information here is for your reference. Thank you.
There are a few things you can do when preparing for outpatient surgery at Aestique Surgical Center. You may have already received your surgical packet from your doctor’s office. The information here is for your reference. Thank you.
INSURANCES AND PAYMENT OPTIONS
As with any surgical procedures there are four separate bills that you will expect to see:
For your convenience, we do accept most insurance plans. For out of network costs, copayments or deductibles, we accept all major credit cards including Visa, MasterCard, Discover, American Express and CareCredit. We will bill you any balance due after your insurance company has paid your claim. We do ask that all balances are paid in full within 90 days. If you encounter a problem paying within the 90 days, please contact our office immediately at 724-832-7555 and ask for our ASC Billing department. Please remember that insurance is a contract between you, the patient, and your insurance company. Ultimately you are responsible for payment in full to Aestique Surgical Center, regardless of insurance determination to pay.
Effective January 1, 2022, the No Surprises Act, which Congress passed as part of the Consolidated Appropriations Act of 2021, is designed to protect patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities, holding them liable only for in-network cost-sharing amounts. The No Surprises Act also enables uninsured patients to receive a good faith estimate of the cost of care.
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care–like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Additionally, Pennsylvania law provides that managed care plans, including health maintenance organizations and gatekeeper preferred provider organizations, and subcontractors of managed care plans cannot deny any claim for emergency services on the basis that the patient did not receive permission, prior approval, or referral prior to seeking emergency service. A managed care plan that has no in-network providers available to provide covered services shall cover services provided by an out-of-network provider. The plan shall cover the out-of-network services at the same level of benefit as an in-network provider.
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
If you believe you’ve been wrongly billed, you may contact:
PREPARING FOR SURGERY
Medication/Anesthesia:
CONFIRMING SURGERY TIME
FOR YOUR FAMILY MEMBERS
FREQUENTLY ASKED QUESTIONS: