Insurance

Insurance

Thank you for choosing SAINT LUKE’S SURGICENTER-LEE’S SUMMIT as your medical provider. We are committed to providing you with quality health care and outstanding service.  This commitment includes sharing information with you in advance about how you will be billed for the health care services you receive in our facility. 

We realize that healthcare is expensive and that insurance coverage and plan requirements are often confusing. Many insurance plans require a deductible payment, co-payment or co-insurance as financial responsibility.  We believe it is important for you to understand your financial obligations ahead of time so that you can make informed decisions regarding your care.   Therefore, we strive to obtain information regarding your insurance coverage and plan benefits in advance, and to communicate that to you in a timely manner.

Please keep in mind that our facility is licensed as an outpatient, ambulatory surgery center.  As such, the procedures we provide are considered non-emergent and elective in nature. If you do not feel you can meet our financial requirements, we recommend that you consult with your physician regarding these concerns prior to having the procedure(s) done. 

Charge Estimates and Third Party Verification/Authorization

We will estimate charges and attempt to obtain/verify third party benefits approximately one week prior to your scheduled procedure (assuming that the procedure is scheduled that far in advance). We will then contact you by phone prior to your procedure to review the financial estimates with you. If we are unable to verify benefits or obtain authorization for your procedure, we will notify you accordingly. 

Our facility will provide an estimate of your charges, related insurance coverage (i.e. what we expect your insurance to pay), your expected out-of-pocket financial responsibility (i.e. what insurance won’t pay but for which you will be responsible) and the amount due as payment from you at the time of service.  Please note that this quote is an estimate only and is based on your physician’s order provided to us at the time of scheduling.   There are instances when additional procedures or implants are deemed necessary by the physician during the surgery or procedure, and these may result in unforeseen costs.  If the procedure(s) that is(are) ultimately performed is(are) different from that which was originally scheduled—and from which benefits were verified and estimates calculated—or if additional procedures are added, the quote of benefits you received prior to your procedure may not be valid.

In addition to the phone call, we will mail you a copy of the quote along with more specific information on our financial policies and payment plan options.  If you are uncertain about your insurance coverage and related benefits, we recommend that you also contact your insurance carrier for details regarding your specific benefit plan. 

Billing to Third Party Payers

We will file a claim to third party payers, with which we are contracted, for services provided to you in our facility if benefits have been verified and authorized, as applicable.  These third party contracts allow for us to file with and accept payment from the payers directly, and to apply pre-negotiated discounts associated with care provided to the carriers’ insured/covered beneficiaries. 

If your insurance (for which we received correct billing information and were able to bill appropriately) has not remitted payment to our facility by the end of sixty (60) working days from the date of service, you will be notified and asked to work with us in contacting your insurance company to ensure that you obtain the benefits due to you under your health plan provisions.  While we will assist you in resolving unpaid claims, please note that having insurance coverage does not absolve you from financial responsibility for services rendered.

We will work with your physician’s office at the time of scheduling to obtain your demographic and insurance information. However, we require that at the time of your surgery or procedure, you present your insurance card and photo identification, as well as any other information that will assist us in ensuring that your claim is filed promptly and correctly.  

We will assist you in any way we can to help make this process as smooth as possibleHowever, you are ultimately responsible for any co-payments, co-insurance, deductibles or non-covered services, as required and indicated by your specific insurance policy.


PAYMENTS AT TIME OF SERVICE AND PAYMENT PLANS

Payments at the Time of Service
Some payments may be required from you at the time services are provided, such as deductibles or co-payments, which are set by your health plan, the purchasers of the health plan, Medicare, Medicare replacement plans or other payers. If your services are covered by a verified third party payer and we anticipate you will have out-of-pocket expenses, you are expected to make payment on the date of service.  
Uninsured and cosmetic surgery patients are required to pay for expected charges in full prior to being admitted. 

Payments
The facility will accept the following forms of payment:

  • Cash
  • Check or money order made payable to the facility
  • Consumer Credit – MasterCard, VISA, American Express, Discover
  • Electronic payments made via the facility website.

Return Checks/Rejected ACH Withdrawals
A $25.00 charge will be added to your account for any checks returned or ACH withdrawals rejected by your bank for any reason in addition to any fees that your financial institution may charge you.

Patient Statements
If your services are covered by a third party payer and you have financial responsibility remaining on your account after the claim has been processed and paid, you will receive a statement from our facility.  This statement will indicate what was charged for your services, any payments you made at the time of service, and subsequent payments made by the third party payer.  You should also receive an Explanation of Benefits (EOB) directly from your insurance carrier indicating similar information.  In general, any remaining patient balance after insurance has paid is due within ninety (90) days from receipt of your first statement. 

Payment Plan Options
The facility now offers payment plan options to assist patients in meeting their financial obligations after insurance payments and discounts have been applied.  To be eligible for a payment plan, you must have an account balance of at least $200.   Options available include:

  • No-interest facility payment plan which requires a minimum payment of $50 via a secure automatic fund withdrawals, over a period not exceeding six (6) months after the last insurance payment date
  • If you require a longer pay-off period and your account balance is at least $500, we have contracted with an outside account management firm who can assist you with a variety of low-interest payment plan options.


Please contact our Billing Office at (888) 472-1330 to review options available to you. 

Any unpaid amounts or defaults from payment plan terms and conditions will result in the consequences of non-payment described below.

Consequences of Non-Payment

  • Balances on delinquent accounts will ultimately be referred to an outside collection agency. 
  • Patients with prior delinquent accounts will be required to pay their collection balance in full prior to all future visits.  
  • Patients with poor payment history or patients who are repeatedly sent to collections will be required to pay in full at the time of service for all future visits. 


Auto Accident/Liability Injury/WORKER’S COMPENSATION

Auto Accident/Liability Injury
If your injury is a result of another party’s negligence and/or due to an automobile accident, we require that you provide us with any information that will assist us in getting your medical claims paid. If your services are due to and/or are payable by a third party, the facility reserves the right to treat the third party as the primary payer. This information may include:

  • a copy of a police report
  • a copy of the vehicle accident report listing claim number and responsible party
  • a copy of your auto insurance policy
  • medical coverage
  • attorney information
  • the names and information of other involved parties.


Workers' Compensation

If your injury is due to an accident in your work place, you must contact your employer and inform them of your injury. We require authorization from your employer before admitting you for services.  Failure to properly report this injury to your employer may result in your claims being denied. Denied claims will be your responsibility.

PRIVATE PAY AND COSMETIC SURGERY FEES

Private Pay Patients
The facility offers discounted pricing for patients not covered by insurance. If you do not have insurance coverage and/or are not able to present proof of coverage, payment in full will be due prior to receiving any medical care in the facility.  Please contact the facility’s Financial Counselor to obtain private pay pricing.

Cosmetic Surgery
If you are having elective cosmetic surgery, you will be required to pay the charges in full at least three (3) days prior to your surgery.  Please contact our Financial Counselor to obtain pricing for cosmetic services.

Doctor and Other Medical Fees

Please note that any estimates we provide are for our facility’s charges only.  You will also be billed separately for professional services rendered by your physician/surgeon, anesthesia providers (if undergoing anesthesia) pathologists (if specimens are taken and submitted for review), and Lithotripsy Services (if undergoing Extracorporeal Shockwave Lithotripsy).  Unless you are a Medicare, Tricare, Coventry Advantra, or Humana Gold PPO, services provided by Mid America Kidney Stone Association (MAKSA) for Lithotripsy Procedures are independently billed to your insurance carrier.  Questions or concerns regarding financial obligations need to be addressed with MAKSA at 816-941-0035.

Colonoscopy General Insurance Coverage Information

Colonoscopy General Insurance Coverage Information
We highly recommend that each patient - regardless age or diagnosis - contact his or her insurance carrier to find out if his or her scheduled colonoscopy procedure will be subject to deductible and coinsurance, or covered under the plan’s preventative care provisions.  

Medicare Coverage

  • Flexible sigmoidoscopy every four (4) years for those 50 and over at average risk
  • Colonoscopy once every ten (10) years for those 50 and over at average risk
  • Colonoscopy every two (2) years for those at high risk


If you are unsure of when you had your last Colonoscopy you may want to reference your “Medicare & You Handbook” for more information on how to contact Medicare regarding the services Medicare covers and how often Medicare deems those services Medically Necessary.

Private Insurance Coverage
We recommend all patients with private insurance check with his or her individual insurance providers to learn the details of his or her individual benefit plan and coverage guidelines.  We also recommend asking about the preventative coverage he or she may have under the Affordable Care Act and how it affects his/her coverage for a Colonoscopy. 

Insurance Quick Links

PAYMENTS AT TIME OF SERVICE AND PAYMENT PLANS

Auto Accident/Liability Injury/WORKER’S COMPENSATION

PRIVATE PAY AND COSMETIC SURGERY FEES

Doctor and Other Medical Fees

Colonoscopy General Insurance Coverage Information


We Accept the following Insurers:

MANAGED CARE PAYERS:

Aetna/Coventry

     Aetna National

               Select, Choice POS II, HMO, Missouri Preferred, Signature Administrators, Federal Employees Health Benefit Plan, Mail Handlers Benefit Plan, Missouri Dept of Trans & State Highway Patrol, Univ. of MO myChoice Health Program

     Aetna Local

               Select Local, Choise POS II Aexcel, Choice POS II Local, Elect Choice, HMO Local, Managed Choice, Open Choice PPO, Coventry Health and Life Ins, Coventry Health, CoventryOne PPO, CoventryOne QHD (PPO), KS CoventryOne

     Other Aetna/Coventry

               First Health Network, Workers Compensation

     Aetna Better Health of Missouri (Medicaid)

American Healthcare Alliance, LLC- PPO

Beech Street - PPO

Blue Cross Blue Shield of Kansas City - PPO

BCBS Anthem PPO (Blue Acess) Plan, Federal, Freedom Network, Freedom Network Select (includes GEHA), Preferred Care, Preferred Care Blue, Traditional

CCO, Inc. (a/k/a Rockport Healthcare) - PPO

Century Health Solutions -  PPO

CIGNA

HMO, PPO, National POS, OAP, Open Access

CompAlliance (Worker's Comp)

CorVel Corporation (CorCare)

     PPO, Workers Compensation

Coventry

HMO, National PPO, OAP, POS, PPO Leased, Health & Life Pro

Coventry ONE (Non-Exchange Plan)

Health Choice of Northwest Missouri -PPO

Humana

     Kansas City PPOx, ChoiceCare, National POS - Open Access, HumanaOne, SmartSuite PPO, SmartExpress PPO, SmartNet PPO, Humana Preferred PPO    

MultiPlan - PPO

Occupational Health Management - PPO

OHARA Managed Care - PPO

Preferred Health Professionals

  Must have FN or FNS logo on the card

Private Healthcare Systems (PHCS) & PHCS Savility

ProviDRs Care Network (formerly WPPA, Inc.)

TRICARE  (Standard, Extra & Prime) - HMO

United Healthcare - PPO

Choice & Choice Plus , Definity Health Reimbursement Account/Savings Account, Golden Rule - HMO, Indemnity & Managed Indemnity, Options PPO

UHC Medicaid - Community Health

 

MEDICARE REPLACEMENT PLANS:

Aetna/Coventry

     Medicare Advantage HMO, PPO, POS, Total Care PPO

     Aetna/Coventry Medicare Advantage PPO (Advantra Freedom)

Blue Cross Blue Shield

    Anthem Smartvalue Classic and Plus Plans
Anthem Blue Cross Blue Shield
BCBS of Michigan
BCBS Medicare Advantage PPO & HMO

Care Improvement Plus

Cigna Medicare

     HealthSpring Preferred (HMO)

Deseret Mututal/Desert Secure

First Seniority Freedom (Harvard Pilgrim Health Care)

HealthMarkets Care Assured

Highmark Freedom Blue

Humana

   Medicare Advantage PPO, HMO

   Central States-TeamCareGold

   Choice Care PPO, HMO

   Gold Choice PFFS

Preferred Care USA

   Pyramid Life Medicare Advantage PPO

Sierra Health Plan - Optima and Optima Plus

Sierra Spectrum (UHC Affiliate)

Today's Options

     PPO, Options Value & Value Plus, Options Preimer, Today's Options PFFS/PPO

    Consitutional Life, Pennsylvania Life, Pyramid Life, Union Bankers

United Healthcare

Medicare Advantage Products HMO and HMO-POS plans under SecureHorizons or AARP Brands:

     Medicare Complete, Complete Essentials, Plus, and Group Retiree Plans

PPO Plans under SecureHorizons or AARP Brands:

    Medicare Complete Choice

    Medicare Complete Essentials,and Group Retiree Plans

    Medicare Special Needs Plans

    Evercare Plan DH thru RMP

AARP Health Medicare Select

    AARP Medicare Supplement Plans

    Universal Health Care (Florida)

    Any PFFS

    USA Care/MVP Health Care

 

120 NE Saint Luke's Blvd.   |   Lee's Summit, MO 64086   |   816-347-5800  (fax) 816-347-5899   |   © 2017 Nueterra. All rights reserved
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