There are a number of separate charges associated with your surgical procedure. You MAY receive charges from several companies.
1. US Pain & Spine Hospital
2. Gulf Anesthesia Associates
3. Baylor College of Medical Anesthesia
4. Your surgeon’s office – his/her fee for performing your surgery.
5. Your pathologist – services for tissue specimens removed during surgery requiring further examination.
6. An extended home health care service.
Full payment is due within 60 days from your date of service. Please contact your insurance company directly if you experience any delays. YOU are responsible for guaranteeing payment on your account and being aware of your individual policy restrictions and benefits.
Your insurance company, including Worker’s Compensation, auto (no fault) and personal injury, is legally responsible to you. Our relationship is with you, our patient, not your insurance company. Consequently, all charges incurred are your responsibility. The obligation to assure payment in a timely manner lies with you regardless of what your insurance company chooses to do. You should normally receive a response from your insurance company within 30 days of your date of service. If you experience a delay, it is expected that you contact your insurance company to check the status of your claim and to expedite payment. Please call our Business Office at 713-528-6200 if you encounter a problem with your insurance company and need our assistance.
US Pain & Spine Hospital’s policy is to turn over to an attorney or collection agency all accounts which are delinquent. You will be responsible for any collection fees that are incurred.
We accept assignment of benefits.
Your copay amount is due on or before your date of service. As a courtesy, we will submit your bill directly to your private insurance company. A bill will be sent to your secondary insurance upon receipt of payment or denial from your primary insurance. If you have no secondary insurance, a bill will be sent to you for any balance after receipt of payment or denial from your insurance company. We must make a copy of each insurance card at the time of registration.
Your Select Care copay amount is due on or before your date of service. As a courtesy, we will submit your bill directly to Select Care. A bill will be sent to your secondary insurance upon receipt of payment or denial from Select Care. If you have no secondary insurance, a bill will be sent to you for any balance after receipt of payment or denial from Select Care. We must make a copy of each insurance card at the time of registration.
You will be contacted prior to your surgery with an estimated procedure cost for your surgery. A down payment equal to 1/3 of the total estimated amount due is expected. You will be asked to complete a financial agreement. The remaining balance will be due within 90 days from your date of service.
You will be contacted regarding an estimated procedure cost prior to your surgery. You will be expected to pay this amount on or before your date of service. Should there be additional charges, you will receive a statement for those charges.
SELF PAY – COSMETIC SURGERY – ELECTIVE SURGERY
Payment in full must be received 10 days prior to surgery.
|FACILTY||TRUDY WIIG, CEO (713) 528-6800|
|STATE||ATTN: KATHRYN C. PERKINS, ASST COMMISSIONER|
|AGENCY||TEXAS DEPARTMENT OF STATE HEALTH SERVICES DIVISION FOR REGULATORY SERVICES HEALTH FACILITY PROGRAM HEALTH FACILITY COMPLIANCE GROUP P.O. BOX 149347 AUSTIN, TX 78714 (888) 973-0022|
|MEDICARE||OFFICE OF THE MEDICARE BENEFICIARY OMBUDSMAN: