Insurance & Billing

If I have a question about my bill or how much my procedure at Summit Surgery Center will be, who should I talk to?

Please call the MedBridge Patient Services Department at 855-633-2743 M-F 8am-5pm. This is a toll-free number, so it won’t cost you anything to call.

How do you determine patient portion costs?

Summit Surgery Center is contracted with several insurance companies. These contracts specify how much money your insurance will allow as payable for a procedure. MedBridge will assess the insurance contract and your plan benefits to estimate your patient portion. If your insurance is out-of-network at our facility, we will do our best to set your patient portion based on your in-network benefits.

When will I be expected to pay the amount that is my responsibility?

You are expected to pay at least part of your patient portion on the date of surgery. If you will not be able to make the payment at that time, please contact MedBridge at 855-633-2743 BEFORE the date of your surgery to discuss your options and to set up a payment plan.

Why am I asked to pay on the day of service?

In keeping with the terms of your agreement with your insurance company, as well as the agreement between the insurance company and Summit Surgery Center, it is our practice to request that you pay at least part of the facility fee on the date of service.

MedBridge does their best to provide you with an estimated facility fee before you receive services. This gives you the opportunity to understand how your health insurance will be applied to the services you receive at Summit. Feel free to ask MedBridge specific questions about your insurance benefits as well as payment plan options.

What is a “co-payment”?

A co-payment (often called “co-pay”) is a set fee that the insured person pays to providers at the time of service. Co-pays are applied to emergency room visits, hospital admissions, outpatient surgeries, office visits, etc.

What is a “deductible”?

Deductibles are provisions that require the insured person to pay a specified amount before insurance benefits are provided. For example, if your policy has a $500 deductible, you must accumulate and pay $500 out-of-pocket before your insurance will begin paying a percentage of service charges. Once you have accumulated and paid your $500 deductible to your medical providers, your insurance plan will start paying a percentage of future medical bills. You are thereafter responsible for your coinsurance. Deductibles typically re-set annually.

What is “co-insurance”?

Co-insurance is a form of cost sharing. After your deductible has been met, your insurance plan will begin paying a percentage of your bill. After your insurance has processed the claim and paid the percentage determined by your plan benefits, you will owe the remaining percentage, or “co-insurance.”

What do the terms “in-network” and “out-of-network” mean?

If you have selected a PPO plan, you will have both in and out of network coverage. Healthcare providers that participate in your health plan are often referred to as “in-network,” and providers that do NOT participate in your health plan may be referred to as “out-of-network.” If Summit Surgery Center is out-of-network, we will check both your in- and out-of-network benefits and do our best to offer a facility fee that is comparable to an in-network provider.

Will Summit Surgery Center submit claims to my primary and secondary insurance?

As a courtesy to our patients, we submit claims to your primary and secondary insurance companies. We will do everything we can to advance your claim, and will contact you if we need your involvement in the process.

What is an “Explanation of Benefits” (EOB)?

An EOB, or Explanation of Benefits, is a letter from your insurance company that provides information about how insurance processed your claim. If you have any questions about your EOB, please call MedBridge.

What should I do if the insurance company sends payment directly to me?

If you receive a check from your insurance company, please immediately call MedBridge at 855-MEDBRIDGE. We will ask you to endorse the check to Summit and send it directly to our office. It is very important that you endorse this check immediately to Summit: it is money due to the facility and is not to be used for any other purpose.

How and where can I pay my bill? What forms of payment are accepted?

You can pay:

Do you balance bill?

No. Our practice does not balance bill. If insurance does not pay the full-billed amount, we will not bill you for what insurance did not pay. You will owe the amount that is discussed with you prior to surgery.

Out-of-Network Policy

Our policy regarding billing patients for “out-of-network” surgeries is based on two central principles:

Your insurance carrier might refer to our surgery center as an “out-of-network” facility. This does not mean that we do not accept your insurance, but it does mean we do not currently have a contract with your particular health insurer. However, if you have an insurance policy with out-of-network benefits (e.g., a PPO policy), you have the additional benefit of visiting physicians and surgical facilities that are outside of your insurance carrier’s network, such as our surgery center.

We choose to stay out-of-network with certain insurance companies to maintain flexibility in optimizing your treatment. By staying out-of-network, we can tailor our processes to suit our surgeons, the surgeries performed here, and, most importantly, our patients. We are pleased to enter into contracts with insurance companies if it is in the best interests of the surgery center’s patients and medical staff.   Of course, contracted rates need to match or exceed our competition’s pricing in the marketplace.  (We generally consider our competition to be the local hospital outpatient departments.)

Our surgery center may choose to remain out-of-network with a specific insurance company because the insurance company cannot or will not offer contracted rates that compare well with those of our competitors. However, we do not want our patients to be financially harmed by our status as an out-of-network provider. For that reason, in determining what to charge a patient who has out-of-network insurance, we try to adjust the patient’s portion of the payment to compare to what the patient might pay in-network. We are able to provide these discounts because we collect at least 50% of the payment on or before the date of service. This comes at a risk to us, since we agree to perform the services without knowing what the insurance company will ultimately pay us.

So, if you are a patient with out-of-network insurance benefits, in most circumstances* we can offer you the following at our surgery center:

This policy is based upon both our concern for patients’ best interests and our need to make sound business decisions. First, we consider our relationships with our patients to be the highest priority. We endeavor to give our patients assurances about the amount they will owe when they come for service at our surgery centers.  Navigating the insurance process is daunting and confusing, and we are committed to helping our patients avoid the stress of these unknowns.

Additionally, we understand that when patients are billed for medical care after they receive service, they are 50% less likely to pay their responsibility.   Therefore, we offer incentives for the patient to pay before, or on, the date the patient receives service, which increases the likelihood of receiving payment and reduces the overall cost of health care by eliminating the need for collections and follow-up with the patient.

We are happy to answer any questions you may have. Please call the MedBridge Patient Services Department at 855-633-2743 M-F 8am-5pm. This is a toll-free number, so it won’t cost you anything to call.

*To be eligible, you must be insured, in good standing with your insurance carrier, and your claim must not be denied. Other exceptions may apply.

Concierge Surgery

To find out more about a luxury, surgical concierge service that offers cash-pay surgical rates, please click here.

kinese logo_tealgrey