Patient Rights and Responsibilities

Conditions of Admission and Authorization for Medical Treatment

Notice of Privacy Practices for Protected Health Information

Advance Directives

Living Will Declaration

Release of Information

Patient Bill of Rights

Insurance Information

Arkansas Surgical Hospital will gladly assist you in filing your insurance claim, provided the hospital has complete information (policy numbers and forms) at the time of admission. If you have visited our Emergency Services department, please remember to notify your insurance company. Your policy may not cover your visit if you do not call. Your insurance contract is between you and your insurance carrier; you have primary responsibility to the Arkansas Surgical Hospital for the amount of the bill.

Patients without insurance will be referred to Patient Financial Services for assistance with financial arrangements. Arrangements can also be made by calling 501.748.8000. Patient Financial Services assists patients or family members with questions or problems concerning the patient’s insurance coverage, payment options, and/or collection procedures. Any self-pay balance will be billed to you by Tiburon. Tiburon is a billing company, not a collection agency. If you have any questions when you receive your statements, please contact the number listed on the statement.

Arkansas Surgical Hospital will bill you for your visit, the supplies, drugs and tests that are ordered. When you have laboratory testing, X-rays or specialty consulting, you will also receive bills from those physicians. Please be aware that you will receive separate bills from the following sources:

Arkansas Surgical Hospital
Your private physician or surgeon
Radiologist (if applicable)
Anesthesiologist (if applicable)
Pathologist (if applicable)

In order for Arkansas Surgical Hospital to bill your insurance company directly, you will be asked to provide your insurance identification (I.D.) card. In the event of an emergency, the card should be presented as soon as possible following admission. You will also be asked to provide any claim or referral forms required by your insurance company.

Note: Failure to provide accurate, current insurance information and required referrals when you are admitted could result in penalties or a reduction of benefits by your insurance company.

Most insurance companies require pre-certification, or approval of admission before a scheduled hospital stay. It is the hospital’s policy to contact a patient’s insurance company to verify eligibility and benefits; however, it is your responsibility to ensure any pre-certification or pre-authorization is obtained prior to the scheduled procedure. Emergency admissions must be “pre-certified” by contacting your insurance company as soon as possible (usually within 24 hours).

Note: Failure on your part to pre-certify with your insurance company could result in a reduction of benefits, or in some instances, a denial of payment by your insurance company for your hospital stay.

Many insurance companies limit the number of days of hospitalization that they will cover, and may limit certain hospital services. Even if you have insurance, you may be responsible for payment of deductibles and co-insurances. Most insurance companies require the patient to notify them prior to the date of admission. Please contact your insurance company for complete information about your benefits and coverage.