Insurance / Billing
We know that health care insurance can be confusing. 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 Wesmark Ambulatory Surgery Center.
- A representative from Wesmark Ambulatory Surgery Center 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 that you have. (Note: You will not receive a call if we do not expect you to have a patient portion).
- 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 Wesmark Ambulatory Surgery Center. Once the claim has been processed by your insurance, you may receive a bill for the balance due or a refund if you have overpaid us.
- Payment of co-pays, coinsurance, and any deductible amounts that are due are expected upon your check-in to the center. A description of each is as follows:
- Co-pay is a form of medical cost sharing in a health insurance plan that requires and insured person to pay a fixed dollar amount when a 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 first be met 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 if services are received form an approved provider or if received from providers not on the approved list.
- Co-insurance is the amount due by the patient after the insurance has paid and applied all deductibles and co-pays. Explanation of Benefits. It 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.
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 our Surgery Center.
- Our bill is from Wesmark Ambulatory Surgery Center, which is the facility fee.
- You will also receive a bill from your physician.
- You may also receive a bill for your anesthesia services. Midlands Anesthesia, our anesthesia provider is a separate entity from the surgery center and will bill your insurance carrier separately.
- If pathology is necessary you will also receive a separate bill from the pathologist.
Wesmark Ambulatory Surgery Center will bill your procedure to your insurance company for the facility portion, and to a second insurance provider, if you have one. 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.