Financial Info

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https://www.patientnotebook.com/MankatoSurgeryCenter/Enhanced/BalanceLookup/Home

When you get emergency care or get 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 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 network.

“Out-of-network” describes providers and facilities that haven’t 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 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 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 they may bill you is your plan’s in network cost-sharing amount (such as copayments and coinsurance). 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.

If emergency services are provided by a nonparticipating provider, with or without prior authorization, the health plan company shall not impose coverage restrictions or limitations that are more restrictive than apply to emergency services received from a participating provider. Cost-sharing requirements that apply to emergency services received out-of-network must be the same as the cost-sharing requirements that apply to services received in-network.

 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 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 care out-of-network. You can choose a provider or facility in your plan’s network.

An in-network provider is permitted to bill an enrollee for services not covered by the enrollee’s health plan as long as the enrollee agrees in writing in advance before the service is performed to pay for the noncovered service.

When balance billing isn’t 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 any additional costs to out-of-network providers and facilities directly.

Generally, your health plan must:

• Cover emergency services without requiring you to get approval for services in advance (also known as “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 in-network deductible and out-of-pocket limit.

If you think you’ve been wrongly billed, you may contact

The Office of the Minnesota Attorney General: https://www.ag.state.mn.us/Office/Forms/ConsumerAssistanceRequest.asp or call (800) 657-3787

Centers for Medicare & Medicaid Services:

https://www.cms.gov/nosurprises/consumers/payment-disagreements or call (800) 985-3059

For more information about your rights under federal law visit https://www.cms.gov/nosurprises

For more information about your rights under Minnesota Law visit https://www.revisor.mn.gov/statutes/cite/62K.11 and https://www.revisor.mn.gov/statutes/cite/62Q.556

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• Make Sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit https://www.cms.gov/nosurprises or call 1-877-696-6775.

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.

The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.

If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill.

You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

There is a $25.00 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on the good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

For Questions or more information about your right to a Good Faith Estimate or the dispute process and dispute forms, visit www.cms.gov/nosurprises or call 1-877-696-6775.

Minnesota Statute requires Surgery Centers to provide an online listing of standard charges using an adopted layout with charge information encoded in accordance with Statute specifications. Mankato Surgery Center supports the intent of these regulations and has made good faith effort to ensure this files accuracy.

Click Here to Access Price Transparency CSV File

The charges listed in this file do not reflect patient’s individual out of pocket expense.

We will ask you for half of the estimated amount due for services prior to services being rendered. You will also be asked to set up payment arrangements for the balance.

The Mankato Surgery Center contracts with other third party healthcare providers for certain aspects of your care. In addition to the charges from your physician and the Surgery Center, you may receive statements from the following contracted providers:

When collecting medical debt, Mankato Surgery Center will treat its patients with honor, dignity, and courtesy; demonstrate compassion; and be good stewards of health care resources. This policy establishes standards for the fulfillment of Mankato Surgery Center’s values in the collection of medical debt. There is zero tolerance for abusive, harassing, oppressive, false, deceptive, or misleading language or collections conduct by Mankato Surgery Center employees who collect medical debt from patients.

Billing:

Mankato Surgery Center bills for facility fees and anesthesia professional fees.  The facility fees are billed separately from anesthesia professional service fees and patients may receive two statements from Mankato Surgery Center.

The Mankato Surgery Center contracts with other third-party healthcare providers for certain aspects of care. In addition to the charges from the physician and the Surgery Center, patients may receive statements from the following contracted providers:  Laboratory, X-Ray Studies, Pathology.

 

Statements and Payments:

• The first statement will be sent after insurance has processed the claim.  Self-pay patients will be sent a statement after the procedure.   Subsequent statements will be sent monthly thereafter.

• There may be a delay in receiving a patient statement if insurance requests additional information or if we have re-submitted the claim for a corrected payment determination.
• Payment or an established payment plan is expected upon receipt of first statement.  Finance charges up to the maximum allowed will accrue after 90 days on any unpaid balance.
• We accept payment by check, credit card or cash.  Payments can be made by phone, mail, in-person or online.  Cash payments should be made in person, not mailed.  To make online payments go to our website www.mankatosurgerycenter.com  and select the “Make A Payment” link.
• To discuss payment plan options, please contact the Business Office as soon as possible.

Payment plans can be set up by patients online through our “Make A Payment” link, the payment duration can range from 1-6 months.  Finance charges are waived if this type of payment plan is established.

Payment plans extending beyond 6 months must be approved and set up by the business office. If a patient has additional services, and additional self-pay balances are owed, Mankato Surgery Center will require increases to the patient’s current payment plan, based on the patient’s ability to pay.

Mankato Surgery Center has partnered with Epic River Patient Lending and Bank Vista to provide financing for an extended time for patients with balances greater than $250.00.  Benefits of this program include:

• Ability to choose the monthly payment amount
  • Financing up to 60 months
  • Minimum monthly payment as low as $20.00
• Fair and Unchanging Interest Rate
  • Discounted rate for auto-pay
• No Credit Check, Fees or Prepayment Penalties

 

Disputes:

Mankato Surgery Center will exercise its best efforts to respond to all questions or disputes regarding a medical bill as soon as possible.  Some inquiries may need to be directed to the insurance company.

• Whenever a patient calls or writes the business office about a particular account, the business office staff will document in the appropriate system any concern of the caller/writer.
• All inquiries should be investigated and resolved within 30 days.  If an inquiry cannot be fully resolved within 30 days the patient will be notified of the status of the inquiry and be given a reasonable estimate of the time needed for resolution.
• Collection activities will be suspended during a dispute.  Collection activities may resume after information has been provided to the patient confirming that the debt is valid.

 

Referral to a collection agency:

Third-party debt collection agencies may be enlisted only after all reasonable collection and payment options have been exhausted.

• A final notice will be sent giving the patient 10 days to make payment, establish a payment plan or dispute the balance.  If none of these actions are taken and it has been at least 120 days since the first statement was sent, the account may be forwarded to a licensed collection agency or law firm (hereafter referred to as agency).
• The account will be reviewed prior to referral to an agency and Mankato Surgery Center will confirm that:
  • There is a reasonable basis to believe that the patient owes the debt.
  • All known Payers have been properly billed such that any remaining debt is the financial responsibility of the patient.
  • Where the patient has indicated an inability to pay the full amount of the debt in one payment, consideration of a reasonable payment plan is required.
• Once an account has been forwarded to an agency any payments made directly to Mankato Surgery Center by the patient will be reported weekly to the agency.  The agency will report payments to Mankato Surgery Center monthly and payments will be applied to the patient’s outstanding balance.
• If a patient contacts Mankato Surgery Center staff regarding the collection of a medical debt after it has been referred to an agency, Mankato Surgery Center staff will refer the caller to the agency for further communication.  If the patient provides staff with new information regarding the patient’s liability for the debt, Mankato Surgery Center staff will contact the agency with the new information and suspend collection activity until the new information has been investigated.   Mankato Surgery Center will not attempt to negotiate a payment plan with a patient once the debt has been referred to a collection agency or law firm for collection.
• If a patient contacts Mankato Surgery Center staff regarding the conduct of an agency under contract with Mankato Surgery Center, information regarding the patient’s concerns will be noted on the patient’s account and reported to management.
• Monthly the agency will cancel and return accounts deemed uncollectable. Accounts will be returned as uncollectable in any of the following circumstances:
  • Patient/Guarantor bankruptcy
  • Patient/Guarantor deceased with no estate
  • Accounts that have reached the statute of limitations
  • Any other situation in which all collection activities have been exhausted and the debt is determined by the agency to be uncollectable.
  • Accounts with active payment plans will be excluded.

 

Denial of treatment due to outstanding debt:

• Mankato Surgery Center will not deny medically necessary health treatments or services to a patient or any member of the patient’s family or household because of outstanding or previously outstanding medical debt owed by the patient or any member of the patient’s family or household to the healthcare provider, regardless of whether the health treatment or service may be available from another healthcare provider.
• As a condition of providing medically necessary health treatments or services, Mankato Surgery Center may require a patient to enroll in a payment plan for the outstanding medical debt.

If you have any questions or concerns about our payment policies, please call our business office at 507.388.6000.

If you feel that your concerns have not been addressed, please contact our office and allow us the opportunity to try to address your concerns.

If you feel your concerns have not been addressed after contacting our office, you have the right to hire your own attorney to represent you in this matter.  You may also contact the Minnesota Attorney General’s Office by telephone at 1.800.657.3787, or online at www.ag.state.mn.us/contact.

Your health care provider is referring you to a facility in which Mankato Clinic and the Orthopaedic and Fracture Clinic have a financial or economic interest.