We understand that having a surgical procedure can be a stressful event, and with so many considerations to make, questions about the billing and payment for services associated with your procedure are sometimes overlooked or somewhat confusing. The following information will hopefully answer some of these questions for you. Please do not hesitate to call our business office (603-431-5563) should you have any further questions.
Please take a brief moment to review this page to help you understand some key points about your insurance as it relates to your procedure at Northeast Surgery Center (NESC).
- A representative from the NESC billing office will contact you prior to the day of your procedure to give you an estimate of your personal portion of the cost of your procedure. This estimate is based on the procedure(s) your physician has scheduled and the type of insurance plan you have. (Note: You will not receive a call if we do not expect you to have a patient portion. However, if after claims are processed there is patient responsibility, you will be billed for the balance). **It is important to know that this is only an estimate.** Sometimes the surgeon needs to do more or maybe even less during the procedure than what is originally scheduled. These changes may affect your final financial responsibility to NESC. Once the claim has been processed by your insurance, you may receive a bill for the balance or a refund if you have overpaid us.
- Payment of co-pays, deductible and coinsurance amounts that are due are expected upon your check-in to the center. A description of each is as follows:
- A co-pay is a form of medical cost sharing in a health insurance plan that requires an insured person to pay a fixed dollar amount when medical service is received. The insurer is responsible for the rest of the reimbursement. There may be separate co-payments for different services. Some plans require that a deductible be met first for some specific services before a co-payment applies.
- A deductible is a fixed dollar amount during the benefit period (usually a year) that an insured person pays before the insurer starts to make payments for covered medical services. Plans may have both individual and family deductibles. Some plans may have separate deductibles for specific services. For example, a plan may have a hospitalization deductible per admission. Deductibles may differ depending on whether services are received from an approved provider or a provider who is not on the approved list.
- Coinsurance is the amount due by the patient after the insurance has applied all deductibles and co-pays. This is the amount that is usually described as “Patient Responsibility” or “Member Responsibility” on the Explanation of Benefits. It is usually a percentage of the allowed amount covered by your insurance (i.e. 80/20; 70/30; 90/10). Because we contract with many insurance carriers, we can determine your coinsurance in advance based on the information received by your physician’s office at the time of scheduling.
- Specialty Lenses: For cataract patients that have chosen a specialty lens, these items are not covered by insurance carriers and aren’t billed to insurance carriers. These lenses are solely patient responsibility, and payment will be collected from you prior to the procedure.
Because there are several healthcare practitioners who are providing a service to you, there will be separate bills generated from each of these providers; therefore, you can plan to expect bills from multiple providers for one procedure at NESC.
- Our bill is from NESC, which is for the facility fee only.
- You will receive a separate bill from both your physician/surgeon and anesthesiologist. They are each separate providers from NESC and will bill your insurance carrier separately.
- You may also receive a separate bill for laboratory and/or pathology fees associated with any obtained specimen examination, etc.
NESC will bill your procedure to your insurance company(s) for the facility portion, but ultimately, you are responsible for the charges associated with your procedure.
Please call us at the numbers above if you have any questions. Thank you.
Because you are responsible for costs for covered healthcare services until you reach your deductible, you should comparison shop if you elect to have a nonemergency procedure.
You can use tools like Healthcare Bluebook and the Medicare Procedure Price Lookup (for Medicare patients). Many health insurance websites also provide information on where to find in-network services.