Financial Policy: Surgery South will verify your insurance eligibility upon receipt of your financial information. To do this, we need you to provide complete and accurate information. We ask that you assist us by informing our staff of any changes in your health insurance, employer, address, marital, or dependent status. Please bring your insurance card and a picture ID at the time of each visit. Patients that are not insured will meet with our financial advisor to discuss financial arrangements required for their care needs.
- Referrals: Many insurance plans require your Primary Care Physician (PCP) to request a referral to our practice. This is submitted by your PCP to your insurance company and when approved, a referral number and/or letter is generated and provided to our office. If you are on a plan with this policy, this referral number must be received by our office prior to your appointment time. Your insurance company will not cover the fees associated with your visit to our office without a referral number and you will be rendered responsible for the payment of the visit at the time of your appointment.
- Fees: Our billing department will submit all covered office visits and surgery fees to your insurance company. Prior to scheduling surgery, information obtained from your insurance company, regarding deductible amounts remaining and co-insurance patient responsibility, we will be discussed with you. This amount must be paid prior the scheduling of elective surgery. Your insurance company denotes General Surgery as a specialist category and the co-pay must be paid at the time of your office visit. There is a $25.00 fee for the completion of forms such as disability, FMLA papers, etc. There is also a $35.00 return check fee. All procedures not covered by your insurance company must be paid in full prior to the time of services.
- Payment Options: Surgery South accepts American Express, Discover, Master Card, Visa as well as personal checks, cash and debit cards. Thank you for your cooperation as we make every effort to continue providing the best medical care.
AUTHORIZATION AND ASSIGNMENT
I HEREBY AUTHORIZE THE RELEASE OF ANY MEDICAL INFORMATION INCLUDING INFORMATION RELATED TO PSYCHIATRIC CARE DRUG AND ALCOHOL ABUSE AND HIV/ AIDS CONFIDENTIAL INFORMATION NECESSARY TO PROCESS INSURANCE CLAIMS OR ANY MEDICAL INFORMATION THAT IS REQUIRED FOR ANY HEALTH CARE RELATED UTILIZATION REVIEW OR QUALITY ASSURANCE ACTIVITIES OR ANY HEALTHCARE PROFESSIONAL REQUIRING THIS INFORMATION. I HEREBY ASSIGN AND AUTHORIZE PAYMENT TO SURGERY SOUTH, P.C. OF ALL MEDICAL AND/OR SURGICAL BENEFITS INCLUDING MAJOR MEDICAL BENEFITS I AM ENTITLED TO UNDER ANY INSURANCE POLICY OR POLICIES ANY SELF INSURED PROGRAM OR UNDER ANY BENEFIT PLAN. I UNDERSTAND AND ACKNOWLEDGE THAT THIS ASSIGNMENT OF BENEFITS DOES NOT RELIEVE ME OF MY FINANCIAL RESPONSIBILITY INCLUDING BUT NOT LIMITED TO PAYMENT OF THOSE FEES AND CHARGES NOT DIRECTLY REIMBURSED TO SURGERY SOUTH, P.C. BY ANY INSURANCE POLICY, SELF-INSURED OR OTHER BENFIT PLAN.