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Insurance & Billing

We recognize that you may have questions or concerns about our insurance and billing procedures. Please use the content of this section to learn about our billing process.

Insurance Plans We Accept

Most Common Insurance Plans We Accept

Security Health Plan

Aetna

Anthem BCBS of Wisconsin

Cigna

UMR

WPPN - Multiplan

WPS

Humana

Medicare

Advocare (Medicare HMO)

Humana Gold (Medicare HMO)

United Healthcare

Auto Insurance/Worker's Compensation

Medical Assistance (Forward Health/Badger Care)

Self Pay

You will be contacted prior to your surgery with an estimated procedure cost for you surgery. A down payment equal to 50% of the total estimated amount due is expected. You will be asked to complete a financial agreement. The remaining balance will be due within 90 days from your date of service.

Self Pay
Cosmetic Surgery - Elective Surgery

Payment in full must be received on or before your surgery.

If your insurance company is not listed, it may be considered to be part of one of the networks listed above. Please call our office at 715-842-4490 and ask to talk with the billing department for more information.

There are a number of separate charges associated with your surgical procedure. You MAY receive charges from several companies.

  1. Wausau Surgery Center, surgical facility fee, 715-842-4490.
  2. Central Wisconsin Anesthesiology, services of an MD Anesthesiologist and/or CRNA (Certified Nurse Anesthetist), 715-845-5505.
  3. Your surgeon's office-his/her fee for performing your surgery.
  4. Your pathologist – services for tissue specimens removed during surgery requiring further examination.
  5. An extended home health care service.

We accept all major credit cards such as Visa, Mastercard, Discover, and CareCredit. You are welcome to visit the CareCredit website at: www.carecredit.com to pre-apply for their services before your date of surgery.

We will bill you any balance due after your insurance company has paid your claim. There may be a delay if your insurance company has paid us incorrectly and we have re-submitted your claim for a corrected payment and allowance determination.

We do ask that all balances are paid in full within 90 days. If you encounter problems paying within the 90 days, please contact our office immediately at 715-842-4490 and ask for our collections department.

We are dedicated to reducing the cost of your medical care. In fact, we do not itemize invoices since most procedures have established charges. You will receive separate invoices from us, your surgeon, RNA, and anesthesiologist, or pathologist. Some specialty items may require additional charges.

You can read our Credit and Payment Policy here.
Full payment is due within 60 days of your surgery. Elective and cosmetic surgery procedures must be paid in full 5 days before your surgery.

We strongly encourage you to personally contact your insurance company about your upcoming surgery. It is mandatory that YOU, as the insurance subscriber, confirm that all prior authorization information necessary to your specific policy is completed before your surgery date. You may be penalized by your insurance company if you don’t follow your policy guidelines. You must understand what your benefits cover and how this may affect you financially.

We will submit insurance claims for you. We may request that your deductible and copay amounts are paid on or before your date of surgery. You will receive a notice from us regarding the amount to pay. Self pay accounts are asked to pay 50% of the total estimated procedure on or before the date of surgery and to also sign a financial agreement keeping in mind that our balances are due within 90 days.

If you anticipate difficulty in paying your bill within the 90 day period please let us know immediately.

There are a number of separate charges associated with your surgical procedure. You MAY receive charges from several companies.

  1. Wausau Surgery Center, surgical facility fee, 715-842-4490.
  2. Central Wisconsin Anesthesiology, services of an MD Anesthesiologist and/or CRNA (Certified Nurse Anesthetist), 715-845-5505.
  3. Your surgeon's office - his/her fee for performing your surgery.
  4. Your pathologist – services for tissue specimens removed during surgery requiring further examination.
  5. An extended home health care service.

Full payment is due within 60 days from your date of service. Please contact your insurance company directly if you experience any delays. YOU are responsible for guaranteeing payment on your account and being aware of your individual policy restrictions and benefits.

Your insurance company, including Worker's Compensation, auto (no fault) and personal injury, is legally responsible to you. Our relationship is with you, our patient, not your insurance company. Consequently, all charges incurred are your responsibility. The obligation to assure payment in a timely manner lies with you regardless of what your insurance company chooses to do. You should normally receive a response from your insurance company within 30 days of your date of service. If you experience a delay, it is expected that you contact your insurance company to check the status of your claim and to expedite payment. Please call our Business Office at 715-842-4490 if you encounter a problem with your insurance company and need our assistance.

Wausau Surgery Center's policy is to turn over to an attorney or collection agency all accounts which are delinquent. You will be responsible for any collection fees that are incurred.

We utilize TransWorld Systems (1-888-446-4733) and Dabuert Law Firm (715-849-3475) as our collection agencies.

Billing/Collections

The Wausau Surgery Center Will Bill as Follows:

Auto Insurance/Worker's Compensation

We will submit your bill directly to your auto insurance/employer/work comp insurance if your procedure is the result of an accident. We must make a copy of your insurance card, be provided with your claim number, date of accident and insurance claim address at the time of registration.

Medicare

We accept assignment of benefits.

Private Insurance

Your copay amount is due on or before your date of service. We will submit your bill directly to your private insurance company. A bill will be sent to your secondary insurance upon receipt of payment or denial from your primary insurance. If you have no secondary insurance, a bill will be sent to you for any balance after receipt of payment or denial from your insurance company. We must make a copy of each insurance card at the time of registration.

Self Pay

You will be contacted prior to your surgery with an estimated procedure cost for your surgery. A down payment equal to 50% of the total estimated amount due is expected. You will be asked to complete a financial agreement. The remaining balance will be due within 90 days from your date of service.

Self Pay - Cosmetic Surgery - Elective Surgery

Payment in full must be received prior to your surgery.

Notice to Patients

Wausau Surgery Center respects a patient’s rights and responsibilities without regard to age, race, color, sex, national origin, religion, culture, physical or mental disability, personal values or belief systems. A copy of this notice is posted in our patient registration area.

If you have complaints which arise, the Wausau Surgery Center maintains a grievance mechanism to resolve them. If you have a complaint you may request a written response. The individual you should address a grievance is:

Sharon Schwartz, Administrator
Wausau Surgery Center
2809 Westhill Drive
Wausau, WI 54401
715-842-4490

If you wish to direct a complaint to the Wisconsin Department of Health, the address is:

ATTN: Cremear MIMS, Director
Wisconsin Department of Health Services
Division of Quality Services
Bureau of Health Services
1 West Wilson Street
P.O. Box 2969
Madison, WI 53701
800-642-6552

Right to Receive a Good Faith Estimate of Expected Charges

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 www.cms.gov/nosurprises or call 1-800-985-3059.

Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center (ASC), 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.

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 the provider or facility 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.

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 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.

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 out-of-network providers and facilities directly.
  • Your health plan generally must:
    • Cover emergency services without requiring you to get approval for services in advance (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 deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, please visit www.cms.gov/nosurprises or call 1-800-985-3059.