Carlsbad Surgery Center

Review: Advice to others - make sure the amount they get up front from you jives with the rate contracted by your insurance.They required the entire surgery facility fee upfront (over 2k). I didn't have time to check with my insurance company to make sure that was the right amount. I presumed the surgery center did their due diligence as they had all my insurance info. A month later, I received my EOB from my insurance company-turns out the surgery center over-charged me by over 1k! I called immediately and asked them to credit my credit card with the refund.They told me it had to be a check and that they would process and mail it within 2 weeks. 3 weeks passed and I called back and was given the 2 week story again. At this point, I told them to call me when the check was ready and I'd pick up myself.They have held my money for nearly 3 months now!The next time I called they said they put in in the mail (against my instructions). Over a week has passed since then - we are both located in Carlsbad - the post office is bad - but not that bad. Still no check! It's just not legit that this refund has taken so long! Don't know if this is their standard business practice or it just happened to me. Their website says they are an affiliate of "Surgery One". I'd suggest anyone who has surgery scheduled with either of these entities confirm with their insurance company the facility cost prior to making their payment.Desired Settlement: I would like the 1k and change refunded to my credit card immediately.

Business

Response:

This patient presented for surgery at our facility with an un-met deductible of $5000.00 at the time of service. It is our policy to collect, up front, any fees that may be owed to us for services provided. In this case, we only asked the patient for $2000.00 of their un-met deductible because of our contracted obligations with the payer. Upon verifying the patients benefits with the patients Insurance Company, the normal disclosure that is stated by them was

“ this is not a guarantee of payment.” Patients are called ahead of time to review the Insurance benefits that were quoted to us by their Insurance Company and discuss any up front fees that are expected to be paid to us upon admission to the facility.

Even though providers and payers have contracted obligations it is very difficult to determine what exactly will be or may be paid by the Insurance Company. Providers bill and Insurance Company’s pay by CPT codes. Upon scheduling most surgical procedures the facility only receives the main or primary CPT code from the scheduling departments of outside providers. In most case’s more than one CPT or procedure may be performed thus making it very difficult to come to an exact amount that patients may be responsible for after surgery.

Most Insurance Company’s take 30days to more than 45days from the time they receive a bill to either make payment or deny the claim. If patients make up front payments to this facility by credit card any refunds owed to them are refunded in the form of a check. This patient has been refunded and was called to verify receipt of that refund. In this case, the Insurance Company was even notified.

In the end, it’s very important that patient’s are aware of their benefits, out of pocket expenses including deductibles, make sure that ALL providers are in their network and that proper authorization has been obtained. Insurance benefits are a direct contract between the patient’s and the Insurance Company’s. In most case’s the Surgery Center doesn’t even see the patient until 90 minutes before the surgical procedure is going to even take place.

[redacted], Administrator

Carlsbad Surgery Center

6121 Paseo Del Norte #100

Carlsbad, CA. 92011

office: (760) 448-2488

fax: (760) 448-2478