At Capstone Surgery Center, we are committed to helping patients understand their rights regarding medical billing. Federal law protects patients from unexpected or “surprise” medical bills when receiving certain services. When you receive emergency care or are treated by an out-of-network provider at an in-network facility such as a hospital or ambulatory surgery center, you are protected from balance billing in many situations.
When you receive medical care, you may be responsible for certain out-of-pocket costs such as copayments, coinsurance, or deductibles. If you receive care from a provider or facility that is not part of your insurance network, you may normally be billed for the difference between what your insurance plan pays and the provider’s full charge. This is known as balance billing.
Surprise billing occurs when you unexpectedly receive care from an out-of-network provider, often in situations where you cannot choose the provider involved in your care, such as during an emergency or when receiving services at an in-network facility.
Services at In-Network Hospitals or Ambulatory Surgery Centers
When you receive care at an in-network facility, some providers involved in your treatment may not be in your insurance network. In these situations, you are generally only responsible for your in-network cost-sharing amounts for services such as anesthesia, pathology, radiology, laboratory services, assistant surgeon services, and certain specialist services. These providers are not allowed to balance bill you or ask you to waive your protections.
You are never required to waive these protections and always have the option to seek care from in-network providers whenever possible.
When balance billing is not allowed:
If you believe you have been incorrectly billed, please contact Capstone Surgery Center directly for assistance.
