Kootenai Outpatient Surgery is a Joint Venture entity separate from Kootenai Health − 51 percent owned by Kootenai Health and 49 percent owned by local surgeons.
Understanding Your Surgery Billing
As you prepare for your surgery, we want to make sure you understand how you will be billed for the services you receive. At a minimum, you will receive three (3) separate bills (surgeon’s bill, anesthesia bill, and our facility bill). Depending on your specific surgery, you may also receive additional bills (e.g. laboratory bill, pathology bill, radiology bill). The success of your surgery depends on a team effort by many dedicated professionals, including those in our facility. Because government and insurance rules do not permit the facility to bill or collect money for all team members, each member of the team will send you a separate bill and collect payment from you separately.
We realize that these multiple bills can be confusing. Our staff will do their very best to help you with questions and guide you to the proper sources of information. If you have any questions about this information, please contact the Billing Department of Kootenai Outpatient Surgery at (208) 625−6422.
Here is an explanation of the bills you will get:
Surgery Center’s Bill
You will get a bill from us for what is known as the facility fee. This fee is for the staff and equipment we provide for your safe and successful experience here. Questions and payments regarding your surgery center billing should be addressed to this office.
Since the physician is not an employee of the center, he/she will bill you separately for his/her services. The physician’s bill will be sent from the physician’s office. You must address all questions and send all payments to that office.
The anesthesia provider will give you either local with IV sedation or general anesthesia and will monitor you throughout the surgery. You will get a separate bill for these services. You must address all questions regarding these services and send all payments to that group or physician. Please call (208) 765−8585 with any questions regarding the billing.
Depending on several factors related to your particular surgery, you might receive services for which you will get additional bills. These additional bills may include:
- Laboratory / Pathology bill, which may include, for example, fees for blood and urine tests or tissue sampling;
- Radiology bill, which may include CT scans, X-rays, and MRI.
You will receive a separate bill from the provider for each of the applicable services. You must address all questions and send all payments separately to each individual provider.
Understanding the Cost of Your Surgery
We know that understanding healthcare related costs is complicated and confusing! In order to help our patients understand their financial obligations as it relates to their surgery, we’ve put together a few important tips.
Before your surgery, be knowledgeable about your benefits. Make sure to contact your insurance provider (their phone number is most often on the back side of your insurance card). Everyone’s policy is just a little different, and the insurance company will have the most accurate and up-to-date information regarding your specific coverage. Be sure to ask a few key questions:
1. Do I have a deductible, and if so, how much of that have I met?
Answer: A deductible is a flat dollar amount that a patient is responsible for paying prior to insurance covering any charges. You could be asked to pay a portion of your deductible at the time of service.
2. Do I have a co-pay?
Answer: A co-pay is a flat dollar amount due in full at the time of service.
3.What is my co-insurance, or the portion of the covered charges that I will be responsible for in addition to my deductible and co-pay?
Answer: Often, insurance policies will pay a certain % of your covered charges, and you will be responsible for anything outside of that %.
4. Are there any exclusions on my policy?
Answer: Some policies have exclusions for specific types of services, for example, dental surgery, Bariatric, cosmetics, etc.
5. Are there any limitations on my policy?
Answer: Some policies only cover up to a certain dollar amount of any surgical episode, which often leaves the patient with a large balance due.
6. Do I need pre-authorization for my surgery?
Answer: Make sure you know if you need a pre-authorization for your surgery. This does not guarantee that your insurance will pay, but it will not pay if you need it and do not have it. Also, the insurance company may penalize you for not ensuring you had a pre-authorization number.
You will be responsible for any covered charges that your insurance does not pay, and having the answers to the above questions can help you avoid any major surprises in your bill. Your employer may also be a good source of information regarding your coverage.
Please do not hesitate to give us a call with any questions and we will be happy to assist you.
Other Financial Information
Kootenai Outpatient Surgery accepts most major insurance plans. Our charges cover standard facility and supply charges. Our standard fees do not include the physician’s fees; anesthesia fees; laboratory and pathology fees; or radiology fees. Most medical insurance covers ambulatory surgery but check with your plan to be certain. Kootenai Outpatient Surgery will bill your insurance plan directly for your convenience.
Payment is accepted in the form of exact cash, check, Visa, MasterCard, or Discover. We also participate in the Care Credit Program.
Patient Rights and Responsibilities
As a Patient, You Have the Right to:
- Quality health care.
- Considerate and respectful care.
- Prompt courteous attention.
- Treatment without discrimination.
- Information about your health care requirements.
- Refuse treatment and medications after an adequate explanation has been given to you by your doctor.
- Identification of all health professionals participating in your care.
- Confidentiality concerning your medical care and related records.
- Present complaints or grievances. Please call, write, or e-mail the director of the surgery center.
- As your surgery date nears, let your doctor know if you develop any sign of illness such as a cold, sore throat, fever, rash, or infection of any kind.
- Keep your appointment. If you are unable to do so, please notify the surgery center and your physician.
- Provide all necessary personal and medical history required for your treatment, which includes updating this information should it change prior to the day of surgery.
- If you do not understand your illness or treatment, just ask questions or request more information.
- Participate actively in your continued care after you leave the surgery center and keep follow-up appointments.
- Supply accurate information for medical history and billing purposes.
- Make arrangement to have a responsible adult to accompany and drive you home following your surgery.