Billing and Insurance Information for Patient
Financial Policy

Dear Patient,

Welcome to Southpoint Surgery Center. We, in the Department of Anesthesia and Perioperative Care, wish to make your stay as comfortable as possible.

During your surgery, you will be given medication to enable the surgeon to operate with as little discomfort to you as possible. Your anesthesia team consists of both Anesthesiologist and Certified Registered Nurse Anesthetists that are contracted members of (SAS) Sunbelt Anesthesia Services, LLC.

SAS, LLC is participating in Medicare, FL Blue and many managed care plans. If you have additional questions regarding our participating insurance plans, you may contact Northstar Anesthesia Billing Services toll free at 1-888-806-0761, prior to surgery. In cases where SAS, LLC do not participate in your insurance plan, but your surgeon and the surgery center do participate, we have found that many insurers will still cover the anesthesia bill in full.

We recommend you contact your insurance company regarding their coverage for anesthesia, prior to your service being rendered. You may be liable for the amount your insurance carrier does not cover, whether or not we participate with your insurance carrier. These amounts may be your co-insurance, deductible or co-pay amounts.

Prior to your surgery, your surgeon might request a consult with Pre-Admission Testing (PAT). After your operation, another team member of the SAS or Southpoint Surgery Center will call you to discuss your care and any questions with the anesthesia you may have.

We would like your time and visit at Southpoint Surgery Center to be as positive of an experience as possible and are hopeful that we can contribute to helping you.

I, ____________________ understand that a scheduled surgery may exceed the projected end time. In the event this occurs, I will be responsible for any additional costs that may be incurred.

I have read and understood the above Financial Policy and consent to the aforementioned terms.

Patient Name: _______________________

Patient Signature: _____________________

Sticker:

Anesthesia Billing Frequently Asked Questions

SUNBELT ANESESTHSIA SERVICES, LLC provides the anesthesia service for your surgical procedure. SUNBELT ANESESTHSIA SERVICES, LLC (SAS,LLC) either collects payment directly or bills your health insurance carrier for the anesthesia service, and the anesthesia service is a separate and distinct claim from any surgical claim issued to your health insurance carrier by the physician specialist. When the anesthesia service is not a covered benefit provided by your health insurance carrier, you are responsible for the anesthesia service balance, and you are mailed a bill for the anesthesia service. Sunbelt Anesthesia Services, LLC accepts cash, personal checks and Master or Visa card payment. We have tried to make the payment options as easy as possible.

Who is Sunbelt Anesthesia Services, LLC? Sunbelt Anesthesia Services, LLC is an anesthesia care team practice model comprised of board certified anesthesiologist, contracted anesthesiologists, Certified Registered Nurse Anesthetists and operational support staff. Our corporate name is Sunbelt Anesthesia Services, LLC, the practice Tax ID number is 90- 0919535, and the practice National Practitioner Identifier (NPI) number is 1205172079.

Who do I contact to determine if my health insurance carrier provides coverage for anesthesia services? Your physician office can obtain any precertification necessary prior to the surgery date, and generally an additional precertification is not required for the anesthesia service. Your health insurance carrier can confirm if the anesthesia service is a covered benefit based on your elected health insurance plan. All insurance plans are different and we strongly recommend you contact your health insurance provider for information about any financial responsibility. (Contact information for the insurance provider is normally located on your insurance card.)

Who do I contact with question(s) about an anesthesia service bill from Sunbelt Anesthesia Services, LLC? Call “MOSS”, dba NorthStar Anesthesia Billing Services at 1-888-806-0761, and please reference Sunbelt Anesthesia Services as your anesthesia provider.

How is the anesthesia service billed and what can I expect to pay? The anesthesia service is billed on a time and complexity basis. Occasionally, claims may be paid as out of network, and in this instance we contact your insurance provider for reconsideration of the claim. It is often beneficial for patients (or primary insured individual) to contact the insurance carrier to request an Explanation of Benefit (EOB) form.

 

How do I submit payment for the anesthesia service?

Online Option: https://sunbelt.healthepayment.com/

Phone Option: Call Northstar Anesthesia Billing Services (888-806-0761) and pay by credit card.

Mail Option: Northstar Anesthesia Billing Services

Attention: Sunbelt Anesthesia Services, LLC PO Box 3024

Plattsburgh, New York

12901-0298.

*Please make payment to SUNBELT ANESTHESIA SERVICES, LLC and include your account number if available, full name, date of service, date of birth and a return phone number.