Office Policies

1. At Surgical Associates of La Jolla, Inc, our goal is to provide excellence in surgery with the individualized and personalized approach of private practice. Surgical Associates of La Jolla is deeply committed to your health and well-being. The following policies have been adopted to try to avoid any patient care confusion and minimize billing questions.
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2. Consent to Medical Treatment: I consent to any medical treatment or physical examination required for myself or for the minor for whom I am legally responsible.
3. Contracted Insurance Plans: It is my responsibility to supply the appropriate billing information. This includes current insurance identification, billing address, and any additional information required by my insurance carrier for payment of claim. I will be required to pay any co-payment, deductible, and/or non-covered services that are considered “non-covered benefits” by my insurer. If my insurance plan does not pay my account, I will be responsible for payment of charges for my medical services, including any denied disputed claims.
4. Non-Contracted / Foreign Insurance Plans: Surgical Associates of La Jolla will bill my insurance as a courtesy. Payment in full is expected at the time of service for international carriers. Upon request, I will be given a copy of my bill that includes the information necessary to bill my insurance carrier. Unpaid accounts will accrue interest at the rate of 1.5% monthly for balances over 60 days.
5. Private/Self Pay: Payment is expected at the time of service. We accept payment in the form of cash, check, or all forms of credit cards. If I am unable to pay at the time of service, I must make arrangements in advance.
6. Returned Checks: If my check is returned, I will be liable for $25.00 plus face value of the check. I may be asked to pay cash for returned checks.
7. Films / Outside Records: When arriving to my appointment it is my responsibility to try to ensure that I have a disc containing any images/scans that have been performed. I will make every effort to be sure that I have paper copies of the reports for those images.
8. High Deductible: If Surgical Associates of La Jolla discovers that my deductible has not been satisfied I will pay the contracted rate allowed by my health plan prior to checking out at my appointment. If I have more than $750.00 remaining on my deductible Surgical Associates of La Jolla will call prior to my surgery being scheduled to pre-collect payment for my upcoming operation/procedure.
9. Copying of Charts: When requesting a copy of my records. The first 10 pages will be at no cost with additional pages charged at a rate of 10 cents per page plus the cost of postage.
10. Release of Medical Information: All records released will need to be accompanied with a signed medical records release. This document can be found on our website under the “Your Visit” section.
11. Disability Paperwork: We understand the importance and urgency of this documentation. We will make reasonable efforts to have submitted forms completed within 2-3 days of receipt. Documentation will not be completed the same day that it is submitted.
12. Patient Forms: EDD forms will be completed at no charge to the patient. Any other forms submitted to the office will incur a fee. Payment must be received prior to the forms being completed.

1-2 Forms: $25.00 Fee
3 or more: Additional $25.00 Fee (Fee not to exceed $50.00 for all forms submitted)

Notice to Patients: Medical doctors are licensed and regulated by the Medical Board of California. I can find more information at (800) 633-2322 or www.mbc.ca.gov. 

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