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
The Patient Has The Right To:
- Appoint a representative or surrogate to exercise the patient’s rights and to make decisions regarding the patient’s healthcare to the extent allowed by State law. The State appointed representative of a legally judged incompetent patient shall exercise the patient’s rights
- Be informed of the patient’s rights and responsibilities prior to obtaining service at the facility. These rights include this Bill of Rights, the facility’s policy on Advance Directives, privacy practices, physician financial interest and ownership, and any relationship of the facility to other healthcare and educational institutions that may influence the patient’s care
- Privacy, dignity and comfort, and to receive considerate and respectful care in a safe setting by competent personnel
- Be free from any act of discrimination or reprisal
- Be free from all forms of abuse, neglect or harassment
- Have an Advance Directive such as a Living Will or Durable Power of Attorney, and expect that the facility will honor the intent of the document to the extent permitted by law, and subject to the facility’s limitations on the basis of conscience
- Expect the facility and its staff to abide by the HIPAA Security and Privacy Rules and that the patient’s personal health information is protected and kept confidential
- Be provided complete information regarding the patient’s health status, evaluation, diagnosis, prognosis, and explanation of treatment including its expected outcome, risks, benefits, and alternatives, and to make informed decisions and consent to treatment based on this information
- Be informed of the credentials of health care professionals providing the patient’s care
- Change providers if other qualified providers are available
- Choose an interpreter or have one supplied by the facility to communicate in the language that the patient understands
- Expect that the facility’s staff is capable of providing appropriate medical care in the event of an emergency
- Expect staff that is committed to pain prevention and management
- Expect that the physician and the facility will provide information and instruction for the patient’s continuing healthcare requirements following discharge
- Refuse treatment to the extent permitted by law and to be informed of the medical consequences of refusal
- Approve or refuse the release or disclosure of the contents of the patient’s medical record to any health care practitioner and/or health care facility except as required by law or third-party payment contract
- Voice suggestions, concerns, or to file a grievance regarding the patient’s care and treatment
- Receive information regarding services available, fees for services, and payment policies
- Be informed of provisions for after hours and emergency care
- Accurately inform staff of correct billing information, including: address, insurance information, phone number, age, and social security number
Provide complete and accurate information to the best of the patient’s ability about the patient’s health, medications, including over the counter products and dietary supplements and any allergies or sensitivities
- Follow the treatment plan prescribed by the patient’s provider
- Provide a responsible adult to transport the patient home from the facility and remain with them for 24 hours, if required by the patient’s provider
- Inform the patient’s provider about any Advance Directive, Living Will, Durable Power of Attorney, or other directive that could affect the patient’s care
- Accept personal responsibility for any charges not covered by the patient’s insurance
- Be respectful of all health care providers and staff, as well as other patients
- If you have concerns about this ambulatory surgery center and the services provided here, please ask to speak with or call the Administrator at (208-625-6428).Or you may contact:
– The Bureau of Facility Standards, PO Box 83720, Boise, Idaho 83720-0009, 208-334-6626 to file a grievance related to quality of care.
– The Joint Commission on Accreditation of Healthcare Organizations, 800-944-6610, to file a grievance related to quality of care.
– All Medicare beneficiaries may also file a complaint or grievance with the Medicare Beneficiary Ombudsman. Call (800) 633-4227 or visit the webpage at https://www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html