Patient Information Booklet

Prior To Your SurgeryBack To The Top

We understand that you may have some questions and anxiety about your surgery – everyone does.  We want you to know that at East Paris Surgical Center outpatient ophthalmic surgery and laser treatment is our specialty.  We will do everything possible to make you feel relaxed and comfortable.

You will be contacted by the East Paris Surgical Center staff a few days prior to your surgery for pre-registration. This will provide the staff an opportunity to relay important information to you about your surgery and give you a chance to ask questions.

Your physician may have ordered some pre-operative (pre-surgery) testing (such as a physical, blood test, EKG) to be completed prior to the day of surgery. In some instances, it may be up to you to have those tests completed. If they have not been completed before the day of surgery, your surgery may need to be rescheduled.

GENERAL HEALTH

You will need to see your Primary Care Physician for a Pre-Operative history and physical.  An EKG and blood work may be required for certain surgical procedures.  It is important that you keep this appointment otherwise the surgical center may cancel your surgery. They must have this information from your doctor.  A letter will be faxed to your doctor that will outline what the surgical center needs in order for you to undergo anesthesia and where they should send the information.  Please DO NOT miss this appointment. If you cannot make it on the date scheduled for you, please call your doctor’s office to reschedule.

If you develop a cold, sore throat, or any other minor illness a day or two prior to your surgery, call your physician.

Medication InstructionsBack To The Top

If you are taking medication for heart, blood pressure, seizure, or reflux – you make them with a sip of water.

If you use an inhaler for asthma or lung disease – you may use the inhaler(s) as directed.

One week prior to surgery:

If you are having glaucoma or full thickness corneal transplant procedures – avoid aspirin, ibuprofen, Coumadin, and other blood thinners for 7 days prior to your surgery date, unless directed otherwise by your physician or it is prescribed for atrial fibrillation, heart valve disease, history of stroke or blood clots – as they increase the chance of bleeding.

Aspirin and other blood thinners CAN be used before cataract surgery.

If you need to take a pain reliever you may take Tylenol. If you have any questions about your prescription medications please ask the physician that prescribed them for you.

Two days prior to surgery (Applies only to Cornea Transplant and Glaucoma Procedures)   

Start administering the following circled eye drops in the operative eye.

Polymyxin-Trimethoprim	Bromsite
Moxifloxacin (Vigamox) DurezolⓇ	Ketorolac (Acular)  IlevroⓇ Besivance

**If taking more than 1 eye drop, wait 3-5 minutes between drops. Wash your hands before instilling drops in eyes.  Store bottle in a clean location.  Place open bottle on a clean surface.

AFTER SURGERY:
You will have an appointment at the office the day after your surgery.

You will need to fill your prescription for: Prednisolone Acetate 1% Ophthalmic Suspension and use these drops according to the schedule that will be given to you at your 1 day appointment. You may NOT drive yourself home from surgery or to your appointment at our office the next day.  PLEASE BRING YOUR EYE DROPS TO YOUR APPOINTMENTS.

The Day Before SurgeryBack To The Top

Do NOT eat or drink anything after midnight.

Do NOT smoke or drink alcohol the day before.

Please shower or bathe the evening before or morning of surgery.

The Day Of SurgeryBack To The Top

Unless you have been instructed otherwise by our nurses, please arrive one hour before your scheduled surgery time to allow time for registration, nurse evaluation, and anesthesia interview.

Please bring your insurance card and picture identification.  If you have an advance directive please bring a copy.  We do not honor advance directives or living wills.  We will resuscitate, stabilize and transfer to the hospital, should an emergency arise.

Leave all valuables at home including jewelry.  If you wear hearing aids or glasses, please bring a case for them.

Wear loose fitting, comfortable clothes.  Do NOT wear make-up, cologne, or body lotion.

A responsible adult must accompany you, stay for the procedure, and drive you home.

Important InformationBack To The Top

For your safety, under no circumstances will you be permitted to leave the Center alone.  If you have not made arrangements for an adult companion, your surgery will be rescheduled.  Your adult companion must remain at the Center during your procedure and must be present for discharge instructions.

Anesthesia:
You will be given one of two forms of anesthetic for your procedure:

• Monitored Anesthesia Care (MAC) – local anesthetic drops or injections are used as well as medications to make you drowsy.
• General – you are put completely asleep

NO eating, drinking or smoking:
It is very important that you do not eat or drink after midnight the evening before surgery unless your physician or the Center’s staff gives you specific instructions to do otherwise.

• This means that you may take ABSOLUTELY NOTHING by mouth; no liquids, no solid food, no gum, no candy.
• Avoid smoking the night before and the day of surgery.
• If you eat or drink before surgery, your procedure will be rescheduled.

Medications:
Some of your medications should be taken and others should be held.  The preoperative nurse will ask you the names of the medications you take and the dosages.  You will be informed prior to surgery what medications you should and should not take.

If you have any questions regarding your medications – please call the Center and ask to speak to one of the nurses, they will help answer your questions.

After SurgeryBack To The Top

After the surgery, you may be sleepy or dizzy.  Plan to relax and enjoy the rest of your day.

The night of surgery you will have a shield over the operative eye.  You should keep the shield in place until it is removed in the office at your appointment the following day.  There is no need to remove the patch and no need to put drops in the night of surgery.  You may continue to use any regular medications in the OTHER eye.  There is usually minimal or mild discomfort after surgery.  A mild scratch sensation and tearing may occur.  You may take Tylenol if needed for the discomfort.

Please call our office at 616-949-2001 if you have any problems or questions.  Our doctors are on call 24 hours a day, every day.

If you experience any of the following problems, you should call the phone number listed above.

CALL YOUR DOCTOR IF ANY OF THE FOLLOWING OCCURS:

• Pain unrelieved by your usual over the counter medication and rest. (While a scratchy sensation is normal, intense pain is not.)
• Nausea and vomiting. (This could be a sign of increased pressure in the eye and is easily treated.)
• Loss of Vision.
• Questions or concerns regarding the results of your first eye surgery. (Please call your doctor’s office PRIOR to the date your second eye surgery is scheduled.)

Surgery Costs & PaymentsBack To The Top

The cost of the surgical services other than your deductible, co-pay, and/or co-insurance is usually covered by most healthcare plans.  We will submit claims directly to all third party payors on your behalf; however, we expect you to work directly with your carrier to have your claim addressed.

All deductibles and co-pays are due the day of surgery.  We will contact you in advance to notify you of the amount.  This amount is an estimate only.  If you do not have insurance you must pay for the surgery prior to the surgery being performed or have made prior payment arrangements with our staff. We do accept MasterCard, VISA, Discover, and American Express as well as payment in cash. We also accept check day of surgery. The actual cost of your surgery depends upon the exact procedure(s) that are done in the operating room and any implants used.

Your payment to East Paris Surgical Center is for the facility fee only.  You will receive separate bills for the professional fees, anesthesia fees, and surgery center fees.

Billing NoticeBack To The Top

Depending on your insurance coverage you may be responsible for three separate payments:

• Professional Fees – Verdier Eye Center (616-949-2001)
• Surgery Center Fees – East Paris Surgical Center (616-464-3430)
• Anesthesiologist Fees – Anesthesia Medical (616-364-4200)

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise 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.

You are protected from balance billing for:

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.

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

When balance billing isn’t 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 pay out-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 believe you’ve been wrongly billed, you may contact The State of Michigan at 877-999-6442 or theCenter for Medicare & Medicaid Services at 877-267-2323.

Visit [https://www.cms.gov/nosurprises] for more information about your rights under federal law.

Patient Bill of RightsBack To The Top

East Paris Surgical Center wants you to have the best possible care. We want you to know what your rights are as a patient, as well the obligations of this surgical center, its staff and the physicians. We encourage you to talk openly with those involved in your care.

As a patient and guest of East Paris Surgery Center, you have a right:

• Patients are treated with respect, consideration and dignity.
• Patients are provided appropriate privacy, personal, during check-in and throughout the evaluation and treatment areas.
• Patient disclosures and records are treated confidentially, and patients are given the opportunity to approve or refuse their release, except when release is required by law.
• Patients are provided, to the degree known, complete information concerning their diagnosis, evaluation, treatment and prognosis. When it is medically inadvisable to give such information to a patient, the information is provided to a person designated by the patient or to a legally authorized person.
• Patients adjudged incompetent under applicable State laws by a court of proper jurisdiction, the rights of the patient are exercised by the person appointed under State law to act on the patient’s behalf. If a State court has not adjudged a patient incompetent, any legal representative or surrogate designated by the patient in accordance with State law may exercise the patient’s rights to the extent allowed by State law.
• Patients are given the opportunity to participate in decisions involving their health care, except when such participation is contraindicated for medical reasons.
• Patients have the right to know what their responsibilities are and how they are to conduct themselves as explained under Patient Responsibilities.
• Patients have a right to know what services are available at East Paris Surgical Center.
• Patients have a right to know what provision(s) are available for after-hours and emergency care.
• Patients have the right to examine and receive an explanation of their bill, regardless of the source of payment.
• Patients have the right to receive care in safe setting.
• Patients have the right to know, in advance, the expected amount of his/her bill, regardless of the source of the payment.
• Patients have the right to know what the payment policies are for East Paris Surgical Center.
• Patients have the right to know if any experimental research will be done during his / her treatment and have the right to refuse it.
• Patients have the right to information regarding the credentials of health care professionals involved in their care or treatment.
• Patients have the right to be informed of any persons other than routine personnel who will observe in his / her treatment, and to refuse that observation.
• Patients have the right to change their provider if other qualified providers are available.
• Patients have the right to be free from all forms of abuse, harassment, discrimination or reprisal.
• Patients have the right to be fully informed about a treatment or procedure and the expected outcome before it is performed.
• Patients have the right to be informed or, as appropriate, the patient’s representative of the patient’s right to make informed decisions regarding the patient’s care.
• Patients have the right to refuse treatment and be informed of the consequences of his / her actions
• Patients have the right to exercise his / her rights without being subjected to discrimination or reprisal.
• Patients have the right to be free from any act of discrimination, reprisal as well as all forms of abuse or harassment.
• Patients have the right to expect quality care and service from East Paris Surgical Center in a safe setting.
• Patients have the right to voice grievances regarding treatment or care that is (or fails to be) furnished.
• Patients have the right to have interpretation services available if necessary.
• Patients have the right to voice grievances regarding treatment or care that is (or fails to be) furnished.

PATIENTS and/or PATIENT REPRESENTATIVES should contact the office of the Medicare Beneficiary Ombudsman at www.cms.hhs.gov/center/ombudsman.asp or the State of Michigan Representation if they have a concern or complaint about East Paris Surgical Center. Anyone may file a complaint against a licensed or certified health care facility or healthcare provider by:

Calling toll-free the State of Michigan Bureau of Community Health Systems Complaint Hotline at 1-800-882-6006 to file an oral complaint or to inquire about filing a complaint

​​OR

Mail written complaints to:
Michigan Department of Community Health
​Bureau of Health Systems, Complaint Intake
P.O. Box 30664
Lansing, MI 48909

As a patient of East Paris Surgical Center, you are responsible for:

• It is the PATIENT’S and / or PATIENT’S REPRESENTATIVE responsibility to read and understand all permits and / or consents to be signed. Patients should ask either the nurse or physician to clarify any information not understood about their care or services.
• It is the PATIENT’S responsibility to provide complete and accurate information to the best of his/her ability about his/her health, any medications, including over-the-counter products and dietary supplements, and any allergies or sensitivities.
• It is the PATIENT’S responsibility to follow the agreed-upon treatment plan prescribed by his/her provider and participate in his/her care.
• It is the PATIENT’S responsibility to notify East Paris Surgical Center on admission if preoperative instructions have not been followed.
• The PATIENT is responsible for his/her actions if they refuse treatment or do not follow preoperative instructions.
• PATIENTS are informed of the responsibility to provide a responsible adult to provide transportation home and to remain with him / her (12 – 24 hours after returning home) as directed by the provider or indicated on discharge instructions.
• It is the PATIENT’S responsibility to provide a responsible adult to remain in the facility during your entire procedure.
• It is the PATIENT’S responsibility to follow the postoperative instructions given by the physician(s) and/or nurses. This includes instructions regarding postoperative appointments.
• It is the PATIENT’S responsibility to contact the physician if any complications occur.
• It is the PATIENT’S responsibility to ensure that all payments for services rendered are made on a timely basis. The patient is ultimately responsible for payment and patient accepts personal financial responsibility for any charges not covered by his/her insurance, regardless of insurance coverage.
• It is the PATIENT’S responsibility to provide financial and/or insurance information regarding who will be responsible for the bill including current address and authorized contact information.
• It is the PATIENT’S responsibility and those accompanying the PATIENT to be respectful of all health care providers and staff, as well as other patients, and to follow the Center’s policies.
• It is the PATIENT’S responsibility to inform his / her provider about any living will, medical power of attorney, or other directive(s) that could affect his / her care.
• It is the PATIENT’S responsibility to notify the administration of the East Paris Surgical Center if the PATIENT or PATIENT REPRESENTATIVE thinks their right(s) have been violated or if the PATIENT has a suggestion, comment or complaint.

Advance DirectivesBack To The Top

You have the right to know that the Center does not honor advance directives and to know where/how to obtain information and forms

1. Although the Center recognizes it is the patient’s right to participate in their own healthcare decisions, it is our policy, regardless of the contents of any advance directive, that if an adverse event occurs during treatment at the Center, we will initiate resuscitative or other stabilizing measures and transfer the patient to an acute care hospital for further evaluation.
2. You may obtain additional information about advance directives at: https://www.michigan.gov/fyit/health/durable-power-of-attorney-for-health-care#:~:text=WHAT%3A,to%20know%20what%20to%20do.

OwnershipBack To The Top

East Paris Surgical Center, LLC is owned in part by the following physicians:

David D. Verdier MD & Karl Siebert MD

Our goal is to provide you with the best care possible in a professional manner.  We are always open to suggestions and we recognize that an issue may arise.  If you have any questions or concerns regarding your rights or responsibilities, or have an complaints or grievances on how these rights were or were not administered, please contact the ASC Director who will investigate the issue.  The ASC Director can be reached at:

East Paris Surgical Center

1000 East Paris Ave SE, suite LL01

Grand Rapids, MI  49546

(616) 464-3430

Patients and/or Patient Representatives should contact the office of the Medicare Beneficiary Ombudsman at www.cms.hhs.gov/center/ombudsman.asp or the State of Michigan Representation if they have a concern or complaint about East Paris Surgical Center. Anyone may file a complaint against a licensed or certified health care facility or healthcare provider by:

Calling toll-free the State of Michigan Bureau of Community Health Systems Complaint Hotline at 1-800-882-6006 to file an oral complaint or to inquire about filing a complaint

                        OR

Mail written complaints to: 

Michigan Department of Community Health 

            Bureau of Health Systems, Complaint Intake

            P.O. Box 30664

            Lansing, MI 48909

If you are a Medicare Beneficiary, you can file a complaint with the Medicare Ombudsman.  Additional information is available from the Office of the Medicare Beneficiary Ombudsman at:

http://www.medicare.gov/navigation/help-and-support/ombudsman.aspx

An “Ombudsman” is a person who reviews the performance of an organization or program, and helps resolve problems that are found. Congress requires that Medicare have a Beneficiary Ombudsman to help people with Medicare.

Good Faith Estimate Explanation