There are a number of separate charges associated with your surgical procedure. You MAY receive charges from several companies.
- Northwest Hills Surgical Hospital for your hospital services – 512-346-1994.
- Capitol Anesthesiology Associates for your anesthesiology services – 512-454-2554.
- Clinical Pathology Laboratories for your laboratory services – 512-339-1275.
- Your surgeon's office - his/her fee for performing your surgery.
- Your pathologist - services for tissue specimens removed during surgery requiring further examination.
- An extended home health care service.
Full payment is due within 60 days from your date of service. Please contact your insurance company directly if you experience any delays. YOU are responsible for guaranteeing payment on your account and being aware of your individual policy restrictions and benefits.
Your insurance company, including Worker's Compensation, auto (no fault) and personal injury, is legally responsible to you. Our relationship is with you, our patient, not your insurance company. Consequently, all charges incurred are your responsibility. The obligation to assure payment in a timely manner lies with you regardless of what your insurance company chooses to do. You should normally receive a response from your insurance company within 30 days of your date of service. If you experience a delay, it is expected that you contact your insurance company to check the status of your claim and to expedite payment. Please call our Business Office at 512-346-1994 if you encounter a problem with your insurance company and need our assistance.
Northwest Hills Surgical Hospital's policy is to turn over to an attorney or collection agency all accounts which are delinquent. You will be responsible for any collection fees that are incurred.
We utilize Financial Corporation of America as our collection agencies.
BILLING/COLLECTIONS
THE NORTHWEST HILLS SURGICAL HOSPITAL WILL BILL AS FOLLOWS:
MEDICARE
Your copay amount is due on or before your date of service. As a courtesy, we will submit your bill directly to Medicare. A bill will be sent to your secondary insurance upon receipt of final reimbursement notification from your primary insurance. If you have no secondary insurance, a bill will be sent to you for any balance after receipt of payment or denial from your insurance company. We must make a copy of each insurance card at the time of registration
PRIVATE INSURANCE
Your copay amount is due on or before your date of service. As a courtesy, we will submit your bill directly to your private insurance company. A bill will be sent to your secondary insurance upon receipt of payment or denial from your primary insurance. If you have no secondary insurance, a bill will be sent to you for any balance after receipt of payment or denial from your insurance company. We must make a copy of each insurance card at the time of registration
SELF PAY
You will be contacted prior to your surgery with an estimated procedure cost for your surgery. You will be expected to pay this amount on or before your date of service. Should there be additional charges, you will receive a statement for those charges.
________________________________________
NOTICE TO PATIENTS
You may contact the following entities to express any concerns, complaints or grievances you may have:
| HOSPITAL |
MARK DENO, ADMINISTRATOR
(512) 346-1994 |
STATE
AGENCY |
ATTN: KATHRYN C. PERKINS, ASST COMMISSIONER
TEXAS DEPARTMENT OF STATE HEALTH SERVICES
DIVISION FOR REGULATORY SERVICES
HEALTH FACILITY PROGRAM
HEALTH FACILITY COMPLIANCE GROUP
P.O. BOX 149347
AUSTIN, TX 78714
(888) 973-0022 |
| MEDICARE |
OFFICE OF THE MEDICARE BENEFICIARY OMBUDSMAN:
www.cms.hhs.gov/Hospital/ombudsman.asp |