Billing & Insurance | Boulder Surgery Center | outpatient surgery center for orthopaedic surgeons and their patients providing surgery facilities and outpatient nursing care in Boulder County | Boulder CO

Billing and Payment Policies

There is no doubt that health insurance benefit plans are confusing. Most plans do not provide 100% coverage for a surgery center (aka “hospital”) bill. Each plan has its own set of rules, exclusions and services that are not covered.

It is your responsibility to be familiar with your specific benefit plan. If you are unsure of your coverage for a particular medical procedure or test, you should call the customer service telephone number on

your insurance card before scheduling the procedure.

Your health insurance policy is a contract between you and your insurance company. As a service to you, Boulder Surgery Center will send a claim to your health insurance company. By working together, we can minimize misunderstandings, payment delays and billing costs. However, you are responsible for any charges not covered by your benefit plan.

Depending on your plan, you may be required to get approval (pre-certification) before you receive hospital services. Even in a life or limb threatening situation, your benefit plan may require you to contact them within 24 hours of receiving hospital care. We will assist you in doing that, but if you don’t obtain approval from your insurance company, you are responsible for paying for your hospital care. Also, obtaining approval does not guarantee that the cost of the service is completely covered by your benefit plan. You will still be responsible for any charges not covered by your benefit plan.

Some insurance companies have established "usual, customary and reasonable" (UCR) maximum dollar amounts they will pay for certain procedures. Any amount of money the insurance company will not pay because it exceeds the UCR amount is your responsibility.

If Boulder Surgery Center does not participate in your insurance plan, you can still receive services here. However, your insurance company will consider our services as "out of network," and you will probably be responsible for paying more of the bill.

Medicare

If you are covered by Medicare, we will send in a bill for you. We accept assignment, but you are responsible for any deductible, coinsurance or non-covered services. You should present a valid Medicare card.

Medicaid

If you have Colorado Medicaid coverage, we will send in a bill for you. We accept assignment, but you are responsible for any co-payment. You should present a valid Colorado Medicaid card.

Colorado Indigent Care Program (CICP)

Boulder Surgery Center does not accept the CICP. If you are enrolled in the program or feel you may be eligible, please contact Boulder Community Hospital’s Financial Counselors to make an appointment. Their phone number is 303-440-2139. Their office is in Suite 190 of the BCH Medical Pavilion, 1155 Alpine Avenue (next to Boulder Community Hospital).

Accident-related Injuries

If you are involved in an accident-related injury, we will submit a claim to your insurance company for you. Any medical expenses that are not paid by insurance are your personal responsibility.

Workers’ Compensation

If your medical care is covered by workers’ comp insurance, we will bill your employer’s health insurer. If the claim is disputed, you are responsible for paying the hospital bill.

Preparing for Your Visit

Please bring these items with you to the hospital:

• insurance cards;

• referrals or pre-certification numbers/information from your physician;

• valid driver’s license or state identification card;

Self-Pay

Self-pay patients are expected to pay in full prior to any scheduled service. Where possible, we will estimate the required payment when you schedule your service. You will receive a prompt-payment discount consistent with the hospital’s managed care contracts. Please contact our business office directly at 303-938-3290 for price estimates. (Please note that we cannot accept personal checks for self-pay patients).

Paying Your Bill

We accept cash, checks, VISA, MasterCard, and Discover. Payment is expected on or before the date of service. If you wish to phone in your payment via credit card, you may call 303-938-3290.

Physician Bills

You will receive separate bills from the physicians (surgeons, anesthesiologists, etc.) involved in your care. If you have questions or concerns about those bills, call the physician’s office or the customer service telephone number on your insurance card.

Keeping Records

It’s your responsibility to ensure that your health benefit plan meets its obligations to you and pays everything it should. An important step in doing that is to keep every hospital (and physician) bill you receive. Likewise, keep all the documentation sent by your health insurance plan. In this way, you can compare the payments made by your insurance company against your health benefit plan.

Questions About Your Bill?

Our business and billing office is available to assist you with questions concerning your hospital bill.

If you have questions prior to your date of surgery or procedure, please contact the business office at 303-938-3290.

If your questions pertain to a visit which has already taken place, please contact our billing service (Pinnacle CBO) directly at 303-280-9101 extension 2115.