Capital City Surgery Center is dedicated to providing patients and families with a safe, professional and efficient atmosphere in the provision of outpatient surgical care.
A continuous quality improvement program serves to enhance our patient’s outcomes while also focusing the entire staff on quality care and customer service. It is the mission of the center to provide excellence within a customer-focused, service-oriented environment.
To download the form you need, click on a link below.
- Patient Rights & Responsibilities
- Financial Agreement Form
- Ambulatory Surgery Center Patient Consent to Resusitative Measures
- Paciente del centro de la cirugía ambulatoria consentimiento de medidas de reanimación
- Post-Operative Discharge Instructions
*Note: These will be tailored to you as a patient after your surgery.
- Capital City Surgery Center Patient Brochure
- Authorization to Release Clinical Records
To view or print these forms, you will need Adobe Acrobat Reader.
About Your Bill
Capital City Surgery Center (CCSC) will make every effort to keep this process as simple as possible. Your surgical procedure will generate several different bills from different sources:
- CCSC’s bill covers the use of the facility and all necessary supplies used during your surgical procedure.
- You will receive separate bills from your surgeon and anesthesiologist.
- Other billable services that may be used during your surgery are laboratory and/or pathology charges, radiology and some specialty items.
Our facility works with your doctor’s office to make sure we have accurate insurance information. We will contact your insurance carrier if there is any question bout our eligibility. If it is determined that you are responsible for the bill in its entirety or just a portion, we will call you before your date of surgery to make payment arrangements. We accept cash, personal checks, Visa, MasterCard, Discover and American Express. Capital City Surgery Center now accepts Care Credit.
Capital City Surgery Center will accept most major insurance plans, including Medicare. We are currently in network with the following insurance plans:
- Blue Cross Blue Shield
- United Healthcare
Capital City Surgery Center will bill your primary insurance and secondary insurance. Upon registration, please provide the staff with a copy of your insurance card, Social Security number and Driver’s License. This will ensure accurate and timely insurance payments.
Prior to your surgery you may receive a call from our Business Office to discuss your estimated out of pocket expense. Any out of pocket estimates are based on Capital City Surgery charges only. You may incur additional charges for other services you receive at Capital City (ie. Anesthesia, Physician Billing etc.).
If you have any questions regarding billing, please contact the Business Office at (919) 322-4800.