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PRIOR TO YOUR PROCEDURE​

• A member of our nursing staff will call you a few days before your procedure to give you the time of arrival and to go over your medical history, medications and any other pertinent information. If you do not receive a call the day before your procedure, please call the center at 862-244-8100.
• It is important that you arrange for a responsible adult to accompany you to our facility and to be available to you for 24 hours post-surgery.
• You may not drive yourself home. 

GENERAL PRE-OP INSTRUCTIONS​

• You should not eat or drink anything 8 hours prior to your procedure. This includes water, gum, candy, etc.
• Leave all jewelry and valuables at home. 
• Please do not wear dark nail polish or contact lenses; bring your glasses.
• Wear loose, comfortable clothing that is easily removed for your convenience.
• Bring an up to date list of your current medications including herbs, vitamins, supplements, and over the counter medications. Make sure to include name, dosage, and how often you take them.
• Medication restrictions: consult your doctor.
• Women of childbearing age will need to provide a urine sample when they arrive at the facility.

• Pre Op testing or Covid testing may be required prior to your surgery. The pre op nurse will discuss this with you on the pre op call. Please make sure you have spoken to a member of our nursing staff before the day of surgery. If you experience a change in your health, such as a fever, please notify your doctor prior to your scheduled procedure.

DAY OF PROCEDURE​

• Please arrive 1 hour prior to your scheduled procedure time.
• Bring a photo ID and insurance card. 
• Upon arrival you will be asked to complete admission and consent forms.
• Following admission, you will be asked to be escorted to the pre op area and will change into a hospital gown and be prepped for your procedure.
• Prior to your procedure, you will meet with the Anesthesiologist, Pre-Operative Nurse, OR Nurse, and   Surgeon. You will have the opportunity to ask any questions you have.
• After meeting with your surgical team, we will take you in for your procedure.
• Your companion may choose to stay in the waiting room, or a staff member will be happy to make a telephone call when you are prepared to leave.

AFTER THE PROCEDURE

• Your physician will provide post-Operative instructions.  The post op nurse will discuss them with you and your companion prior to discharge. You will also be provided a written copy. 
• Once you meet the centers discharge criteria you will be discharged with the assistance of a nursing staff member
• A member of our nurse staff will call you the day after surgery to check on your progress and discuss any questions you may have. If you have an emergency, please do not call the center.  Call your doctor or go to the nearest Emergency Room.

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WEST MORRIS SURGERY CENTER

OUT OF NETWORK DISCLOSURE FORM

On behalf of West Morris Surgery Center (hereinafter “health service provider” or “West Morris Surgery”), kindly accept this disclosure in accordance with P.L.2018 c. 32, (“Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act”) as it applies to health care providers and physicians. Pursuant to this new legislation, notice is required to be provided by all health care providers,   physicians, and health centers, including West Morris Surgery, as follows:

Health care providers are required to inform patients whether or not they participate in certain health insurance plans. Please note that West Morris Surgery is considered an “in-network” provider with/for the following insurance companies/plans:

• AETNA
• CHN (Consumer Health Network) 
• PARADIGM
• HORIZON BCBS 
• BCBS CASUALTY
• MEDICARE 

West Morris Surgery has agreed to accept the rate of reimbursement for services performed at West Morris Surgery Center as offered and reimbursed in accordance with these aforementioned plans, subject to co-pay, deductible, and/or co-insurance, as may be applicable. For all other plans/companies not listed above West Morris Surgery is considered an “Out-of-Network” Provider.  If you have any questions, or do not see your health insurance plan listed above, please contact a representative at West Morris Surgery Center to assist you.

West Morris Surgery is a Medicare participant; meaning West Morris Surgery will accept the rates of reimbursement in accordance with Medicare coverage provided to its patients subject to all applicable co-pay, deductible and/or co-insurance.

Please take notice that, upon request prior to the scheduling of  non-emergency procedure(s), you may request  in writing, the amount, or estimated amount that will be billed by West Morris  Surgery for the medical treatment and/or health care service you receive . 

You may be financially responsible for   services provided that are deemed “out-of-network” by your health insurance carrier, including costs in excess of, but not limited to, co-pay, deductible, and/or coinsurance (if applicable). West Morris Surgery reserves the right to seek additional reimbursement from you for procedures or services in excess of those  benefits provided by your health insurance benefits plan and/or rates of reimbursement allowed by your health benefits plan for “out-of-network” providers, in excess of, and in addition to, co-pay, deductible, or co-insurance (if applicable).

Please take notice that it is advised that you contact your insurance carrier with any questions and for   further consultation on costs.

  You can also contact West Morris Surgery Center at 862-244-8100 with questions. 

 West Morris Surgery, is required to provide you with the name, practice name, mailing address, and telephone number (if that information is known or available) for any health care provider providing services in conjunction with those provided by West Morris Surgery to the extent applicable, when that health care provider is providing the following services:

• Anesthesiology—Upon request
• Laboratory/Pathology—LabCorp or Pathline

You can find the contact information for these providers on the West Morris Surgery website.

Physicians’ services provided at the facility are not included in the facility’s charges. Your physician may or may not participate with the same health care plans as the facility. It is advisable for you to  check with the physician arranging for services  to determine the  health benefits plans in which they participate.

Please note that by signing this document, you acknowledge that you have reviewed this document and have received all of the required disclosures listed above and that you hereby waive any challenge to the notice requirements contained within P.L. 2018, c.32, also known as “Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act” and wish to proceed with your treatment/health service/health care at West Morris Surgery.

UNDERSTOOD AND AGREED:

Patient Signature                   Date

Patient Printed                         Name

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WEST MORRIS SURGERY CENTER

FACILITY IN-NETWORK DISCLOSURE

Patient Name ___________________________    Health Benefits Plan __________________________

• West Morris Surgery Center is in-network for the health benefits plan named above and your financial responsibility to this facility will be no greater than the in-network copayment, deductible, and/or coinsurance amount.
• You should contact the health care professional, such as your doctor, or the physician assistant or advanced practice nurse who ordered the services, to determine if they are

in-network or out-of-network for your health benefits plan.

• In some cases, health care professionals other than the one ordering the service may provide and bill for care in this facility.  You can access information regarding the health benefits plans that these health care professionals participate in on our website (www.westmorrissurgery.com).  If you do not have internet access, a copy of this information will be provided to you upon request.
• If you receive any bills from in-network providers for more than the in-network copayment, deductible, and /or coinsurance amount, you can report this information to your insurance carrier or to the Department of Health at (800)-792-9770.  If the bill is from a health care professional, you should report this information to the appropriate professional licensing board in the Division of Consumer Affairs, Department of Law and Public Safety at (973)-504-6200.  The amount you owe at an in-network provider will not be more than any in-network copayment, deductible, and/or coinsurance amount per your health benefits plan.
• If you specifically select an out-of-network provider, you will be asked to sign an acknowledgement of out-of-network provider services, which may exceed your in-network copayment, deductible, and/or coinsurance amount.
• You should contact your health benefits plan for information regarding your copayment, deductible and/or coinsurance amount.  Contact information is typically found on the card provided to you by your health benefits plan. 
• WMSC staff will notify you in the event the in-network status of WMSC changes before services are provided.

      _______    I agree that I have read and understand this form and have been provided a copy of it.

Patient’s Signature:                                             Date:

 We would love to hear from you about your experience at our surgery center. Please take a few moments to complete the form below with any comments and/or suggestions.. Thank you for your time, and we look forward to serving you again.