There are a number of separate charges associated with your surgical procedure. You MAY receive charges from several companies.
1. Upland Outpatient Surgical Center
2. Your Surgeon's Office
3. Your Anesthesiologist
4. Any Pathology required
Full payment is due within 90 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 909-981-8755 if you encounter a problem with your insurance company and need our assistance.
Upland Surgical Center'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 utilize Credit Management Services as our collection agencies.
Your co-pay amount is due on or before the day of surgery. We will submit your bill directly to you private insurance company. A bill will be sent to your secondary insurance upon receipt of payment or denial from your primary carrier. If you do not have secondary insurance, a bill will be sent to you for any unpaid amount. We must make a copy of any and all insurance cards you have at the time of your check in.
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.
SELF PAY - COSMETIC SURGERY - ELECTIVE SURGERY
Payment in full must be received 10 days prior to surgery.
NOTICE TO PATIENTS
Federal and State Regulations require that every ambulatory surgery center post a copy of the "Patient's Rights and Responsibilities" in a prominent place in the center. Ours is available for you to see in the waiting room.
Should you have any complaints arising from these Rights, the Upland Outpatient Surgical Center maintains a grievance mechanism to resolve them. If you have a complaint, you may request a written response by addressing your complaint to:
Brian Olson, Administrator
Upland Outpatient Surgical Center
1330 San Bernardino Rd., Suite F
Upland, CA 91786
Or you may address your complaint to either of the following:
Kathleen J. Billingsley, RN
California Department of Public Health
Center for Health Care Quality (CHCQ)
P.O. Box 997377 MS 3000
Sacramento, CA 95899
Office of the Medicare Beneficiary Ombudsman