Insurance Coverage

Insurance Coverage and Additional Information on Payment Options

Health Insurance

If you are covered by health insurance, please remember this is a contract between yourself and the insurance carrier. We will submit all insurance claims for you, including secondary insurance. However, to ensure proper processing of your claims, it is vital that you supply our office with accurate and up-to-date information at the time of your surgery. This includes any necessary patient-completed forms your insurance carrier may require, and a current copy of your insurance card. Any amount not paid by an insurance carrier would be the patient’s responsibility.

Deductibles/Co-Pays

Depending on your insurance plan, you may or may not be responsible for a deductible and/or co-pay. Please contact our Billing Department if you have questions regarding your financial responsibility. The Billing Department can be reached at 858-657-0055.

Patient Statements

Outpatient Surgery Center of La Jolla will bill all claims for our patients. After payment is received from your insurance carrier, we will then send you a patient statement for any uncovered balance. This is a service that Outpatient Surgery Center of La Jolla is happy to provide to our patients. Prompt payment in full is expected upon receipt of the statement.

Worker’s Compensation or Accident-Related

Our office will submit an insurance claim to the responsible workers’ compensation carrier, as long as all information necessary to submit the claim is given to us prior to the date of service. We will call to confirm authorization by the workers’ compensation carrier prior to the day of surgery.

Medicare Part B

Outpatient Surgery Center of La Jolla does accept assignment on Medicare Part B claims. By “accepting assignment”, we agree to adjust your charges to Medicare’s “approved amount”. Medicare will also send the payment directly to our office. In some cases your physician may want to do a procedure that is not listed with Medicare, if the center knows about this procedure prior to surgery we will notify the patient as to the non-coverage, and give the patient options of coming to the Center. If the procedure is performed without patient prior notification, there will be no expense to the patient.

Medicare typically pays 80% of the approved amount for covered procedures after you have met your annual deductible. You are responsible for your deductible and the remaining 20% balance of the facility fee. If you have a supplemental insurance policy, we will submit any balance to them after we receive the Medicare payment. You do not need to submit anything to your supplemental insurance, nor do you need to send us a copy of your Explanation of Medicare Benefits. Once your supplemental insurance has paid Outpatient Surgery Center of La Jolla, you will be sent a statement and you will be responsible for any remaining balance.

If you do not have a supplemental insurance policy, any deductible and/or co-payment is your responsibility. We will send you a statement of your balance after we receive payment from Medicare.

Cash Accounts

Outpatient Surgery Center of La Jolla is happy to work with cash paying patients. The center offers a variety of payment plan options. Please contact our Billing Department at 858-657-0055 to discuss your best option. All checks returned for reason of “Non-Sufficient Funds” will be charged a $25.00 processing fee.

Collection Policy

When you register for services at the Outpatient Surgery Center of La Jolla, you sign an agreement with the Center which states that you understand it to be your full responsibility to pay for the services rendered by the Center regardless of your type or amount of health insurance. You also consent for us to directly bill your insurance carrier for the covered portion of the charge. We expect that you will meet this payment obligation, and pay your bill in full within the billing date defined upon your statement.

If it becomes evident that a patient does not intend to take care of his/her financial obligation to the Outpatient Surgery Center of La Jolla, a collection agency and/or legal action may be implemented to settle the debt.

Other Questions

Feel free to call the Center with any other questions you may have. We will be happy to answer them for you; Our telephone number is 858-657-0055. It is our aim to work with the patient. We are happy to be of service to you in any way we can help.