Common Contracts
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Re: Non-Participating Provider Agreement Patient:December 12th, 2013
It is the intention of Monocacy Surgery Center to extend “in-network benefits” to all of our patients. Your insurance company will pay the surgery center as a non-participating provider and it is our intention to honor their payment without additional cost to you than if we were a participating or “in-network” provider. It is possible that your insurance payment for your visit to Monocacy Surgery Center, LLC will be sent directly to you. In the event payment is sent directly to you, please endorse the check over to the center, and mail the check along with the Explanation of Benefits you will receive from your insurance provider. By sending such payment you receive directly to the center you avoid the possibility of additional costs for using our facility. Compliance with this request will allow us to process the payment to your account quickly and efficiently, and to make any necessary adjustments without the need to bill you for services due to non-payment.
