Insurance and Billing
When you have surgery at The Surgery Center of Rhode Island, you (or your insurance company) will receive bills for the following types of services:
- The Facility (which is us)
- Your Surgeon
- Laboratory – should your surgeon send any specimens out to a lab for further testing
Our facility will notify you ahead of time should you be responsible for any co-pays, deductibles, or premium charges. We accept all major credit cards as well as check and cash. We do expect payment on the day of surgery.
Should you request a payment arrangement or have questions regarding your responsibility for the Facility charge, please contact our billing department at 860-667-5942 x327. Our billing company is Constitution Billing and Financial Services (CBFS).
Anesthesia will be billed by New England Medical Billing & Coastline Anesthesia, LLC and their billing department can be reached at 401-453-0666.
Any questions regarding the surgeon’s fee should be directed to their office.
||To discuss your bill or make payment arrangements in your own language, please call 860-785-6651
||لمناقشة فاتورتك أو إجراء ترتيبات الدفع بلغتك، يُرجى الاتصال بالرقم 6651-785-860
||Para discutir su factura o realizar acuerdos de pago en su propio idioma, llame al 860-785-6651
||Pour vous entretenir au sujet de votre facture ou prendre des dispositions pour le paiement dans votre propre langue, veuillez appeler le 860-785-6651
||Per discutere in merito alla bolletta o prendere accordi di pagamento nella tua lingua, chiama il numero 860-785-6651
||ដើម្បីពិភាក្សាអំពីវិក្កយបត្ររបស់អ្នក ឬរៀបចំការទូទាត់ជាភាសារបស់អ្នក សូមទូរស័ព្ទទៅលេខ 860-785-6651
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||Jeśli chcec omówić rachunek lub dokonać płatności w swoim języku, zadzwoń pod numer 860-785-6651
||Para discutir sua conta ou fazer acordos de pagamento em seu próprio idioma, ligue para 860-785-6651
||Если вы хотите обсудить счет или договориться об оплате на своем родном языке, позвоните по телефону 860-785-6651
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Your Rights and Protections Against Surprise Medical Bills
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, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s
“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays 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 plan’s deductible or annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t 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. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
You’re protected from balance billing for:
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services. Rhode Island law provides that carriers, including health maintenance organizations, nonprofit hospital service corporations, and nonprofit medical service corporations, cannot deny your claim for emergency services on the basis that you did not receive authorizations prior to seeking emergency services from an out-of-network provider. If you receive emergency services from an
out-of-network provider, the carrier cannot limit your coverage more than as applied to an in-network provider and can only charge you an amount equal to the greatest of the following:
(1) the cost-sharing requirements imposed if services were provided by an in-network provider,
(2) When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible. The amount calculated by using the same method the plan generally uses to determine payments (e.g., the usual, customary, and reasonable amount) for out-of-network services, or
(3) the amount that would be paid under Medicare for emergency services. 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 can 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 types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections. You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network. When balance billing isn’t allowed, you also have these protections: You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
Generally, your health plan must:
o Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
o Cover emergency services by out-of-network providers.
o 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.
o Count any amount you pay for emergency services or out-of-network services
toward your in-network deductible and out-of-pocket limit.
If you think you’ve been wrongly billed, you may call the federal agencies responsible for enforcing the federal balance billing protection law at: 1-800-985-3059 and/or file a complaint with the Rhode Island Department of Business Regulation Insurance Division at 1-401-462-9520
or submit a complaint at:
Visit cms.gov/nosurprises for more information about your rights under federal law.
You have the right to receive a “Good Faith Estimate”
explaining how much your health care will cost
Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are
- You have the right to receive a Good Faith Estimate for the total expected cost of
any health care items or services upon request or when scheduling such items or
This includes related costs like medical tests, prescription drugs,
equipment, and hospital fees.
- If you schedule a health care item or service at least 3 business days in advance,
make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
• If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
For questions or more information about your right to a Good Faith Estimate, visit
www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-