Billing
St. Louis Surgical Consultants, while affiliated with St. Luke’s Hospital, is a privately owned practice and may not accept the same insurance plans as the hospital. Billing is also separate. Your St. Luke’s statement covers hospital charges, while your St. Louis Surgical statement covers the fee for your surgeon. St. Luke’s financial aid does NOT apply to St. Louis Surgical charges, anesthesia charges, or pathology charges.
For questions or concerns about your St. Louis Surgical Consultants billing statement please contact our billing company (RCM360) at 1-855-245-8035. Payment plans are available to fit EVERY budget.
For questions or concerns about your St. Luke’s Hospital statement or bill please contact St. Luke’s Patient Financial Services at 314-576-8100.
Insurance
Our physicians are considered “Specialists.” Because of this, HMO insurance plans require an insurance referral from your primary care provider before they will allow you to see a Specialist. It is your responsibility to obtain this referral from your primary care provider before you can be seen in our office.
There are hundreds, if not thousands of insurance plans that our patients could potentially belong to. While we are in-network with the vast majority of these it is always a good idea to check your individual plan, so that there are no surprises. To do this, call the number on the back of your insurance card (“Member Services”). Give them the name of the provider you are planning to see. They will be able to check your specific plan to verify that you have in-network benefits. “Out of network” benefits means that you will likely have to pay more out of pocket and/or have a higher deductible.
Always check with your insurance company about your benefits.
We do NOT accept the following insurances (not an all-inclusive list):
- Cigna Connect & SureFit
- Coventry FocusedCare & Carelink
- MissionPoint Health Partners
- HFN, Inc
- IDPA & Meridian Health Plans
We are “Out of Network” for the following insurances (not an all-inclusive list):
- Missouri Care
- Coventry Total Care
St. Louis Surgical Consultants, while affiliated with St. Luke’s Hospital, is a privately owned practice and may not accept the same insurance plans as the hospital.
Good Faith Estimates
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 provided.
- 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 services. 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 scheduling. 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 1-800-985-3059
Your Rights and Protections Against Surprise Medical Bills
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.
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 network.
“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:
Emergency services
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.
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:
- 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, please contact our office and ask to speak with the Office Manager (314-434-1211). The federal phone number for information and complaints is 1-800-985-3059. Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.