What to Expect

To schedule your appointment at Florida Spine Associates, please call (561) 495-9511 or request an appointment online.

Now that you’ve decided to have surgery, what next? 

• Plan your visit to The Spine Center at Boca Raton, FL.
• Contact your insurance company. Many insurance companies require preauthorization for hospital admissions. Also be sure that we have your most current and complete insurance information. 
• Compile a list of all prescribed and over-the-counter medications you take, including dosage and strength. Bring it with you on all your visits.
• If appropriate, prepare your Advanced Directives with instructions about who should oversee your medical treatment in case you’re unable to speak for yourself. Advanced directives include a Health Care Power of Attorney and a Living Will. 
• Arrange for a person to drive you home after your surgery or accompany you on public transportation. You will not be allowed to drive yourself home after same-day surgery.
• Designate a person responsible for your care who can listen to the Surgeon’s recommendations, stay with you for 24 hours after surgery and accompany you to your first post-operative appointment..
• If you smoke, stop smoking immediately to reduce your risk of respiratory and anesthesia complications after your operation.

Do’s and Don’ts

Before surgery, routine testing needs to be done, such as blood tests, chest X-rays or electrocardiograms (EKG). This should be arranged through your Primary Care Physician  (PCP). Once you have the okay for surgery by both your PCP and your insurance company, be sure to adhere to the following guidelines prior to, and on the day of, surgery:

Feeling Ill?

• If you develop a cold, persistent cough, sore throat, fever or any other illness within two days of surgery, notify your Surgeon immediately.

 Crutches

• Obtain ambulatory aides such as crutches or knee rollators before surgery; practice using them before surgery. These can be obtained through our office.  

Medication, Anesthesia

• You will be instructed in advance as to which of your routine medications you should take on the day of your surgery. Let us know if you have any special concerns and/or issues with anesthesia.

Food/Drink

• Do not drink alcohol 24 hours prior to surgery.
• You can drink up to 8 ounces of clear liquids up to 2 hours before your arrival time.
• Do not eat or drink anything (including gum, mints or candy) two hours before your arrival time. You may brush your teeth on the day of surgery.

Documents

• Bring a photo ID, insurance information and copay (if applicable) on the day of surgery.

Clothing, Jewelry, Valuables

• On the day of surgery, wear loose-fitting clothing and low-heeled shoes. If staying overnight, a bathrobe and slippers are suggested. Leave all valuables including jewelry, money and credit cards at home.
• Remove all piercings.
• Avoid the use of hair clips, pins and bands that bind your hair. Do not use hairspray. 
• Remove all nail polish. To ensure accurate monitoring of oxygen levels during surgery, remove tips, wraps, gels, etc. from at least one finger on each hand.
• Do not wear makeup or perfume.
• Do not make any marks on your skin to indicate the surgical site. Your physician along with your participation will mark the surgical site prior to your surgery.

 Glasses/Contacts

• You may wear hearing aids on the day of surgery.
• Bring your contact lens and solution and/or glasses case.

Beginning January 1, 2022, patients have a right to an estimate of the cost of services they will receive during a procedure or surgery, called a Good Faith Estimate, and more protection from unexpected, or surprise, bills when they receive care from out-of-network providers at in-network facilities. These protections are part of the Consolidated Appropriations Act of 2021 which includes the No Surprises Act.

Good Faith Estimate

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 inwriting 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 healthcare 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.
• Make sure to save a copy or picture of your Good Faith Estimate and the bill.

What is “balance billing” (sometimes called “suprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other 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” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay, 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 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.

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.

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). 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.

You may be entitled to additional protections under Florida law. See below for details.

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 may 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 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 may be entitled to additional protections under Florida law. See below for details.

You are never required to give up your protection from balance billing. You also are not required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing is not allowed, you also have the following protections:

• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will payout-of-network providers and facilities directly.
• Your health plan generally must:
  • Cover emergency services without requiring you to get approval for services in advance (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 deductible and out-of-pocket limit.

If you think you’ve been wrongly billed, you may contact the U.S. Department of Health and Human Services’ No Surprises Helpdesk at (800) 985-3059, which is the entity responsible for enforcing the federal balance or surprise billing protection laws.

Review the Model Disclosure Notice (CMS version 2 guidelines) for more information about your rights under federal law.

Florida law

If you are covered under certain types of health plans, including health management organizations (HMOs), preferred provider organizations (PPOs), and exclusive provider plans (EPOs), you may be entitled to additional protections against balance billing under Florida law.

Contact the Florida Office of Insurance Regulation at (850) 413-3140 or visit the https://www.floir.com/ for more information about your rights under Florida law.

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 (800) 985-3059.