Pediatric Surgery Information

Thank you for choosing a Charlotte Eye Ear Nose & Throat Associates, P.A. physician for your child’s surgery needs.

Our surgery centers respect your privacy and will follow HIPAA guidelines.

Charlotte Eye Ear Nose & Throat Associates, P.A. does not discriminate on the basis of race, color, national origin, age, or disability; in admission of access to, treatment in, or employment in its programs and activities.

PRE-SURGERY INSTRUCTIONS

Your child may eat a normal meal before 10 p.m. the night before the procedure or as his or her doctor has instructed. Please follow the food and beverage guidelines below, unless otherwise instructed by the anesthesiologist. Failure to follow these guidelines will result in your child’s procedure being delayed or cancelled.

• Water: Do not give to your child within 4 hours of surgery
• Clear liquids (including water, soda, and apple juice)*: Do not give to your child within 4 hours of surgery
• Breast milk*: Do not give to your child within 6 hours of surgery
• Infant formula*: Do not give to your child within 8 hours of surgery
• Dairy/other food*: Do not give to your child after 10 p.m. the night before surgery

*No more than 8 oz. (1 cup)

A parent or legal guardian must accompany all patients under 18 years of age. Proof of legal guardianship must be provided. A consent form must be signed by the parent or legal guardian before medications or treatment can be given.

Each child must be accompanied by a parent or legal guardian. Please make arrangements for you or the child’s legal guardian to accompany the child to their procedure, remain in the waiting room during the procedure, and drive or accompany the child home. Your child’s procedure will be cancelled without a responsible adult available to accompany your child at discharge.

To help facilitate the pre-surgery process, you may be contacted by several individuals prior to your child’s procedure.

Health History: You will be contacted by a nurse to review your child’s health history. Based on your child’s health history, you may need to schedule a pre-surgery anesthesia services appointment.

Arrival time: Plan to arrive two hours before the procedure, unless otherwise instructed by your child’s physician or facility.

Illness: If your child experiences a rash, fever, cold, cough, infection, or other physical change within a week before the procedure, please notify your child’s doctor.

Care at Home: Your child will require care after the procedure. You should make proper care arrangements in advance for when your child returns home. The length of time care may be needed will depend on the type of procedure.

Hygiene: Please ensure that your child has bathed before his or her procedure. Refrain from using lotions, powders, oils or perfume. Your child should not be wearing makeup or nail polish on the day of his or her procedure. Please do not attempt to remove any hair around the area where the procedure will take place.

Clothing: Please ensure that your child is dressed in comfortable clothing, preferably a button-up shirt or blouse. Wearing this type of shirt or blouse will make it easier for your child to dress after the procedure. For your child’s safety, before the procedure, he or she will be asked to change out of his or her clothes and into a hospital gown. Your child may wear his or her pajamas to the hospital. Please bring extra diapers or undergarments to your child’s procedure.

Important documents: Please bring your child’s picture ID, all health insurance cards and proof of guardianship.

Comfort items: If your child has a comfort item, such as a blanket, pacifier, toy, bottle, or cup, please bring this item with you and have available for your child immediately after his/her scheduled procedure.

Valuables: Your child’s valuables, including jewelry (including body piercings) and money, should be left at home. All body piercings will need to be removed prior to your child’s surgical procedure.

Medication: Your child should take daily medications as instructed by the anesthesiologist, with a sip of water. Failure to follow this instruction may result in cancellation of your child’s procedure. If your child is currently using a CPAP machine and/or inhaler, please bring it on the day of the procedure.

Allergies: On the day of the procedure, please inform us of any allergies your child may have, including medications, latex, food, adhesives, etc.

For your comfort, a waiting room will be provided for you during your child’s procedure. So that we may keep you updated on your child’s status, you or your child’s guardian must stay in the waiting room at all times. The length of stay in the recovery room will depend on the type of procedure and anesthesia your child has received. You or your child’s guardian will be kept informed of his or her progress.

PATIENT RIGHTS AND RESPONSIBILITIES

PATIENT RIGHTS

Decision Making

You and your representative have the right to:

• Receive complete information, to the extent known by the physician, regarding your child’s current health status (diagnosis, treatment and prognosis) in terms you can understand.
• Participate in care-planning treatment and discharge recommendations.
• Receive an explanation of the proposed procedure or treatment, including risks, serious side effects and treatment alternatives.
• Make informed decisions regarding care and treatment.
• Participate in managing your child’s pain effectively.
• Request a specific treatment.
• Refuse or discontinue a treatment to the extent permitted by law and to be informed of the consequences of such a refusal.
• Request a second opinion.
• Have persons of your choice and your physicians promptly notified of admission.
• Make advance directives (such as a living will, healthcare power of attorney, CPR directive, mental health treatment, etc.) and to have those directives followed to the extent permitted by law.
• Accept, refuse, or withdraw from clinical research.
• Choose or change your healthcare provider.
• Receive care and/or a referral according to the urgency of your child’s situation. When medically stable, your child may be transferred to another facility after the need has been fully explained.
• Effective communication.
• Respect for your cultural and personal values, beliefs, and preferences.

Quality of Care

You have the right to:

• Respectful care given by competent workers who recognize and maintain your child’s dignity and values.
• Care in a safe setting.
• Identification of all healthcare providers.
• Know who is primarily responsible for your child’s care.
• Information about continuing healthcare requirements following discharge.
• Be informed about your child’s treatment or procedure and the expected outcomes of care, including unanticipated outcomes before it is performed.
• Care without regard to race, color, religion, disability, sex, sexual orientation, age, or national origin.
• Refuse any drugs, treatment, or procedures, to the extent permitted by law, after hearing the medical consequences of refusing the drug, treatment, or procedure.
• Be free from all forms of abuse or harassment.

Confidentiality and Privacy

You have the right to:

• Personal Privacy.
• Personal information being shared only with those who are involved in your child’s care.
• Confidentiality of your medical and billing records.

Grievance Process

You and your representative have the right to:

• Contact CEENTA at 704-295-3000 to file a formal grievance.

Access to Medical Records

You have the right to:

• Review and receive a copy of your child’s Medical Record at any time.

Seclusion and Restraints

Your child has the right to:

• Be free of any sort of restraint unless medically necessary.
• Be free from seclusion or restraint for behavioral management unless there is a need to protect their physical safety or the safety of others.

Billing

You have the right to:

• A complete explanation of your bill.

PATIENT RESPONSIBILITIES

Providing Information

You have the responsibility to:

• Provide accurate and complete information about your child’s present medical complaints, past illnesses, hospitalizations, medications, and other health-related matters.
• Report perceived risks in your child’s care and unexpected changes in your child’s condition.
• Understand your child’s treatment plan and ask questions when needed.
• Provide accurate and updated information for insurance and billing.

Involvement

You have the responsibility to:

• Actively participate in your child’s treatment by following your child’s recommended treatment plan.

Respect and Consideration

You have the responsibility to:

• Act in a respectful and considerate manner toward healthcare providers, other patients, and visitors. Physical or verbal threats are not tolerated.
• Respect the property of others.
• Be mindful of noise levels.

Insurance Billing

You have the responsibility to:

• Know the extent of your insurance coverage.
• Know your insurance requirements such as pre-authorization, deductibles and co-payments.
• Fulfill your financial obligations as promptly as possible.

INSURANCE AND BILLING INFORMATION

We understand that having a surgical procedure can be a stressful event with many considerations to make and questions about the billing and payment for services. The following information will hopefully answer some of these questions for you. Please do not hesitate to call our Business Office should you have any further questions.

INSURANCE INFORMATION

We know that healthcare insurance can be confusing. Please take a brief moment to review this page to help you understand some key points about your insurance as it relates to your child’s procedure at the Surgery Center.

• Payment of co-pays, coinsurance and any deductible (a description of each is as follows) are due approximately three days prior to your procedure. A representative from CEENTA can take your payment over the phone, in person or assist you with setting up credit options through Care Credit.

1. Co-Pay – a form of medical cost sharing in a health insurance plan that requires an insured person to pay a fixed dollar amount when a medical service is received. The insurer is responsible for the rest of the reimbursement. There may be separate co-payments for different services. Some plans require that a deductible first be met for some specific services before a co-payment applies.
2. Deductible – a fixed dollar amount during the benefit period (usually a year) that an insured person pays before the insurer starts to make payments for covered medical services. Plans may have both individual and family deductibles. Some plans may have separate deductibles for specific services. For example, a plan may have a hospitalization deductible per admission. Deductibles may differ if services are received from an approved provider or if received from providers not on the approved list.
3. Coinsurance – the amount due by the patient after the insurance has paid and applied all deductibles and co-pays. This is the amount that is usually described as “Patient Responsibility” or “Member responsibility” on the Explanation of Benefits. It is usually a percentage of the allowed amount covered by your insurance (i.e. 80/20; 70/30; 90/10). We will do our best to determine your coinsurance in advance based on the information received by your physician’s office at the time of scheduling.

• It is important to know that this is only an estimate. Sometimes the surgeon needs to do more or maybe even less during the procedure than what is originally scheduled. These changes may affect your final financial responsibility to CEENTA. Once the claim has been processed by your insurance, you may receive a bill for the balance due or a refund if you have overpaid us.

BILLING INFORMATION

Because there are several healthcare practitioners who are providing a service to you, there will be separate bills generated from each of these providers; therefore, you can plan to expect bills from multiple providers for one procedure at the Surgery Center.

• One bill is from the Surgery Center, which is the facility fee.
• Your physician’s bill will be from Charlotte Eye Ear Nose & Throat Associates, P.A.
• One bill is from your anesthesiologist.
• You will also receive a bill for your Certified Registered Nurse Anesthetist or CRNA.
• If pathology is necessary, you will also receive a separate bill from the pathologist.

Ultimately, you are responsible for the charges associated with your procedure.

Please call us at 704-295-3000 if you have any questions. Thank you.

FREQUENTLY ASKED QUESTIONS

Q. Why don’t you give me the time of my surgery the same day you book the surgery?

A. Since we book appointments so far in advance, we want to confirm the time with the physician and the facility before giving you an exact time.

Q. How much will the surgery cost?

A. A CEENTA representative will contact you prior to your procedure to give you an estimate of cost. If you do not hear from them, it is because we don’t expect for you to have a patient portion.

We highly encourage you to contact your insurance provider to determine your benefits for outpatient surgery.

Q. When is my money due?

A. Approximately five days prior to surgery all co-pays, coinsurance and any deductible are due and can be paid at 704-295-3000.

Q. Why do I get so many bills?

A. There are multiple healthcare providers and systems delivering your care, and you will get a bill from each of them.