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Billing and Insurance .. .. ..
Surgical Fees
Health Insurance
Deductibles/Co-Pays
Patient Statements
Worker's Compensation or Accident-Related Claims
Medicare Part B
Cash Accounts
Collection Policy
Other Questions
Related Links
Surgical Fees
La Jolla Orthopaedic Surgery Center has adopted a "Global Fee"
approach to pricing. This involves establishing one price for each procedure
code. We adhere to that price, regardless of what minor variations in
supplies or time units are utilized by the patient, This global fee includes
the following: Admission Unit, Operating Room, Recovery Room, Discharge Unit
and Telephone Follow-Up.
You should also be aware that you will be receiving a separate bill from your
Surgeon and your Anesthesiologist and Pathologist. If you have any questions
regarding your bill from La Jolla Orthopaedic Surgery Center, please call us at (858) 657-0055.
Questions regarding your bill from any other entity, should be directed to
their respective billing department.
Health Insurance
If you are covered by health insurance, please remember this is a contract
between yourself and the insurance carrier. We will submit all insurance
claims for you, including secondary insurance. However, to ensure proper
processing of your claims, it is vital that you supply our office with
accurate and up-to-date information at the time of your surgery. This
includes any necessary patient-completed forms your insurance carrier may
require, and a current copy of your insurance card. Any amount not paid by an
insurance carrier would be the patient's responsibility.
Deductibles/Co-Pays
Depending on your insurance plan, you may or may not be responsible for
a deductible and/or co-pay. Please contact our Billing Department if
you have questions regarding your financial responsibility. The Billing
Department can be reached at (858) 657-0055.
Patient Statements
La Jolla Orthopaedic Surgery Center will bill all claims for our patients.
After payment is received from your insurance carrier, we will then send you
a patient statement for any uncovered balance. This is a service that La
Jolla Orthopaedic Surgery Center is happy to provide to our patients. Prompt
payment in full is expected upon receipt of the statement.
Worker's Compensation or Accident-Related Claims
Our office will submit an insurance claim to the responsible workers'
compensation carrier, as long as all information necessary to submit the
claim is given to us prior to the date of service. We will call to confirm
authorization by the workers' compensation carrier prior to the day of
surgery.
Medicare Part B
La Jolla Orthopaedic Surgery Center does accept assignment on Medicare Part B
claims. By "accepting assignment", we agree to adjust your charges
to Medicare's "approved amount". Medicare will also send the
payment directly to our office. In some cases your physician may want to do a
procedure that is not listed with Medicare, if the center knows about this
procedure prior to surgery we will notify the patient as to the non-coverage,
and give the patient options of coming to the Center. If the procedure is
performed without patient prior notification, there will be no expense to the
patient.
Medicare typically pays 80% of the approved amount for covered procedures
after you have met your annual deductible. You are responsible for your
deductible and the remaining 20% balance of the facility fee. If you have a
supplemental insurance policy, we will submit any balance to them after we
receive the Medicare payment. You do not need to submit anything to your
supplemental insurance, nor do you need to send us a copy of your Explanation
of Medicare Benefits. Once your supplemental insurance has paid La Jolla
Orthopaedic Surgery Center, you will
be sent a statement and you will be responsible for any remaining balance.
If you do not have a supplemental insurance policy, any deductible and/or
co-payment is your responsibility. We will send you a statement of your
balance after we receive payment from Medicare.
Cash Accounts
La Jolla Orthopaedic Surgery Center is happy to work with cash paying
patients. The center offers a variety of payment plan options. Please contact
our Billing Department at (858) 657-0055 to discuss your best option. All
checks returned for reason of "Non-Sufficient Funds" will be
charged a $25.00 processing fee.
Collection Policy
When you register for services at the La Jolla Orthopaedic Surgery
Center, you sign an agreement with the Center which states that you understand it to be your full responsibility
to pay for the services rendered by the Center regardless of your type or amount of health insurance. You also consent for us to directly bill your insurance carrier for the covered portion of the charge. We expect that you
will meet this payment obligation, and pay your bill in full within the
billing date defined upon your statement.
If it becomes evident that a patient does not intend to take care of his/her
financial obligation to the La Jolla Orthopaedic Surgery Center, a collection
agency and/or legal action may be implemented to settle the debt.
Other Questions
Feel free to call the Center with any other questions you may have. We will
be happy to answer them for you; Our telephone number is (858) 657-0055. It
is our aim to work with the patient. We are happy to be of service to you in
any way we can help.
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