What You need to know about Billing and Insurance at Valhalla Surgery Center.
If I have a question about my bill or how much my procedure at Valhalla Surgery Center will be, who should I talk to?
Please call the MedBridge Patient Services Department at 855-633-2743 M-F 8am-5pm. This is a toll-free number, so it won’t cost you anything to call.
How do you determine patient portion costs?
Valhalla Surgery Center is contracted with several insurance companies. These contracts specify how much money your insurance will allow as payable for a procedure. MedBridge will assess the insurance contract and your plan benefits to estimate your patient portion. Once your in-network insurance processes our claim, we will bill per the terms of the explanation of benefits according to your plan benefits, incorporating any payment made on your date of service. If your insurance is out-of-network at our facility, we will do our best to set your patient portion based on your in-network benefits.
When will I be expected to pay the amount that is my responsibility?
You are expected to pay at least part of your patient portion on the date of surgery. If you will not be able to make the payment at that time, please contact MedBridge at 855-633-2743 BEFORE the date of your surgery to discuss your options and to set up a payment plan.
Why am I asked to pay on the day of service?
In keeping with the terms of your agreement with your insurance company, as well as the agreement between the insurance company and Valhalla Surgery Center, it is our practice to request that you pay at least part of the facility fee on the date of service.
MedBridge does their best to provide you with an estimated facility fee before you receive services. This gives you the opportunity to understand how your health insurance will be applied to the services you receive at Valhalla. Feel free to ask MedBridge specific questions about your insurance benefits as well as payment plan options.
What is a “co-payment”?
A co-payment (often called “co-pay”) is a set fee that the insured person pays to providers at the time of service. Co-pays are applied to emergency room visits, hospital admissions, outpatient surgeries, office visits, etc.
What is a “deductible”?
Deductibles are provisions that require the insured person to pay a specified amount before insurance benefits are provided. For example, if your policy has a $500 deductible, you must accumulate and pay $500 out-of-pocket before your insurance will begin paying a percentage of service charges. Once you have accumulated and paid your $500 deductible to your medical providers, your insurance plan will start paying a percentage of future medical bills. You are thereafter responsible for your coinsurance. Deductibles typically re-set annually.
What is “co-insurance”?
Co-insurance is a form of cost sharing. After your deductible has been met, your insurance plan will begin paying a percentage of your bill. After your insurance has processed the claim and paid the percentage determined by your plan benefits, you will owe the remaining percentage, or “co-insurance.”
What do the terms “in-network” and “out-of-network” mean?
If you have selected a PPO plan, you will have both in and out of network coverage. Healthcare providers that participate in your health plan are often referred to as “in-network,” and providers that do NOT participate in your health plan may be referred to as “out-of-network.” If Valhalla Surgery Center is out-of-network, we will check both your in- and out-of-network benefits and do our best to offer a facility fee that is comparable to an in-network provider.
Will Valhalla Surgery Center submit claims to my primary and secondary insurance?
As a courtesy to our patients, we submit claims to your primary and secondary insurance companies. We will do everything we can to advance your claim, and will contact you if we need your involvement in the process.
What is an “Explanation of Benefits” (EOB)?
An EOB, or Explanation of Benefits, is a letter from your insurance company that provides information about how insurance processed your claim. If you have any questions about your EOB, please call MedBridge.
What should I do if the insurance company sends payment directly to me?
If you receive a check from your insurance company, please immediately call MedBridge at 855-MEDBRIDGE. We will ask you to endorse the check to Valhalla and send it directly to our office. It is very important that you endorse this check immediately to Valhalla: it is money due to the facility and is not to be used for any other purpose.
How and where can I pay my bill? What forms of payment are accepted?
You can pay:
By telephone with a credit or debit card by calling MedBridge at (855)-MEDBRIDGE
By mail by sending your billing statement and payment (by check, credit or debit card) to Valhalla Surgery Center, 121 Gray Ave., Suite 200, Santa Barbara, CA 93101
In person at Valhalla Surgery Center (by cash, check, credit or debit card)
Do you balance bill out-of-network insurance?
No. Our practice does not balance bill. If insurance does not pay the full-billed amount, we will not bill you for what insurance did not pay. You will owe the amount that is discussed with you prior to surgery. Learn more about the No Surprises Act below.
Your Rights and Protections Against Surprise Medical Bills
When you receive emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or must pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you cannot control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency Services
If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most the provider or facility may bill you is your plan’s in- network cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
California state law has similar protections to the federal No Surprises Act.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections.
You are NEVER required to give up your protections from balance billing. You also are not required to get care out-of-network. You can choose a provider or facility in your plan’s network.
California state law has similar protections to the federal No Surprises Act.
More information can be found at California Department of Managed Care Surprise Medical Bills Fact Sheet: https://www.dmhc.ca.gov/Portals/0/HealthCareInCalifornia/FactSheets/fsab72.pdf
When balance billing is not allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
Your health plan generally must:
Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by out-of-network providers.
Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact the Centers for Medicare and Medicaid Services at CMS at www.cms.gov for your rights under federal law.
For more information about your rights under California state law, visit California Department of Managed Health Care at www.dmhc.ca.gov or California Department of Insurance at www.insurance.ca.gov.