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Credit & Payment Policy

There are a number of separate charges associated with your surgical procedure.  You MAY receive charges from several companies.

  1. Fayetteville Ambulatory Surgery Center
  2. Fayetteville Anesthesia
  3. Your surgeon's office Surgeon - his/her fee for performing your surgery.
  4. Your Pathologist - services for tissue specimens removed during surgery requiring further examination.


An extended home health care services if ordered by your surgeon.

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 910-323-1647  if you encounter a problem with your insurance company and need our assistance.    

Fayetteville Ambulatory Surgery Center's policy is to turn over to a collection agency all accounts which are delinquent.  You will be responsible for any collection fees that are incurred.
We utilize First Point as our collection agencies
                 

BILLING/COLLECTIONS

MEDICARE
We accept assignment of benefits.

PRIVATE INSURANCE  
Your copay amount is due on or before your date of service.  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.

SELF PAY
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 prior to surgery. 


NOTICE TO PATIENTS

A copy of our patient’s rights and responsibilities are posted in our patient lobby and if you have any complaints which arise out of these rights, Fayetteville Ambulatory Surgery Center maintains a grievance mechanism to resolve them.  If you have a complaint, you may request a written response.  The person to whom you should address a grievance is:

Teresa L. Craven, RN
Administrator
Fayetteville Ambulatory Surgery Center
1781 Metromedical Drive
Fayetteville, NC 28304
910-323-1647

If you wish to direct a complaint to the North Carolina Department of Health, the address is:

 
NC Contact Information
Rita Horton, Division Contact
North Carolina Dept. of Health and Human Services
Division of Health Service Regulation
Complaint Intake Unit
2711 Mail Service Center
Raleigh, NC 27699-2711
1-800-624-3004 (within North Carolina)
or
919-855-4500
Medicare Contact info: Office of the Medicare Beneficiary OMBudsman
www.cms.hhs.gov/center/ombudsman.asp