Knoxville Orthopaedic Surgery Center

Patient Resources

Financial Policy

The staff of Knoxville Orthopaedic Surgery Center is committed to providing quality care. If you have medical insurance we want to help you receive your maximum allowable benefits. We will be happy to process your insurance claim. In order to achieve this we need your assistance and understanding of our financial policy.

INSURANCE
You will be responsible for all amounts relating to deductibles and co-pays at the time of service. Your insurance carrier will be billed and if payment is not received with a reasonable amount of time, you will be asked to resolve any issues with your insurance company and if we are unsuccessful, we will have to bill the guarantor for payment in full. It is your responsibility to contact the carrier since we are not a party to the agreement between you and your insurance company.

MEDICARE/MEDICAID
We will be a provider for the Medicare/Medicaid program. All Medicare members will be responsible for the deductibles and the 20% Medicare allowable.

SELF PAY
You are responsible for payment in full on the date of service, unless further financial arrangements have been made.
There will be a 24% collection fee incurred for placement with a collection agency. NSF check will be charged $39.00 and the patient will also be responsible for any attorney fees associated with their account.
I have been informed of the financial policy for KOSC and a copy has been provided for my records.
___________________________________________ _____________________
Signature Date
(Responsible party or Authorized party)/authorized party relationship

*********************************EXCLUDED FEES*******************************
You will receive separate billing from your Physician, Anesthesiologist, Pathology, Durable Medical Equipment Vendor (If ordered by physician), and any medications prescribed for home use. These services may be subject to interest, collection fees and/or reasonable attorney fees for any unpaid balances.


256 Fort Sanders West Blvd • Building 8 • Knoxville, TN 37922 • 865-244-4580