Montgomery Eye Center (ASC)

FINANCIAL ASSISTANCE ARRANGEMENTS

We only schedule procedures at this facility by physicians who are on the medical staff at the facility.  If your physician has determined that special financial assistance may be warranted and the physician agrees to those special financial arrangements for his or her services, you may be eligible for special financial assistance at the facility.  If your physician or the physician’s office staff have agreed to provide special financial assistance to you for a procedure the physician wants to schedule at this facility, please contact us. Please be advised that we do not provide charity care. However, we may provide a reduced fee depending upon your financial assistance needs and our verification of eligibility.

We will require you to complete an application for financial assistance that provides us with information about your income and expenses. This will allow us to access your need and qualifications for special financial assistance. Confirmation of eligibility includes verification of your household income through paycheck stubs, receipts for payment of mortgage or rent and utilities, last year’s tax filing, and information regarding changes since the last tax filing occurred. We follow the most recent poverty guidelines set by the U.S. Department of Health and Human Services.

Since these special financial arrangements do not apply to all patients, each patient should request individualized information particular to his or her financial situation.

COLLECTIONS

Prior to your scheduled procedure, we will contact you with the results of the verification of your insurance benefits to advise of your insurance deductible and co-payment amounts that will be due from you prior to your surgery. We expect the amount estimated due to be paid on the day of your surgery when you register at our admission desk.

If you need special consideration for payment of the amount due, you must contact us prior to the date of the planned procedure so we can evaluate your eligibility. You may be eligible to pay your balance monthly over a period of three months. This is based upon your income and expenses that are verified per our charity care policy and take into consideration that, while you do not meet federal poverty guidelines for charity care, you may quality for a payment plan if we can verify your income is less than four times the federal poverty level.

If we received denial of payment from your insurer or Health Maintenance Organization, we will notify you. If we receive payment from your insurer or HMO that is less than projected, we will notify you of additional payment due. Payment will be expected within 15 days of notification of the balance due.  Failure to pay the balance due by the deadline will result in your account being turned over to a collection agency.

If you have notified us in advance that you have no insurance and will pay cash for your procedure, you may be eligible to receive a discount on your estimated charges for payment in advance of the scheduled procedure. You must attest that you have no insurance. If the procedure performed by your physician differs from the one scheduled, you may owe the difference between the scheduled procedure and the actual procedure performed. The balance, if any, will be due within 15 days. Failure to pay the balance will result in the discount arrangement being null and void and a full payment will be due.