Welcome to our Patients Resource Center

Our patient resources encompass a wealth of essential information, covering everything from procedural details to pre- and post-operative care instructions. We understand the importance of privacy, which is why we offer comprehensive details outlining our commitment to protecting your personal information.

Additionally, our patient resources include vital financial information regarding Medicare, insurance coverage, and alternative payment options to help you navigate the financial aspects of your care. We want to ensure that you feel informed and empowered to make the best decisions for your health and financial well-being.

We're here to support you every step of the way. Explore our patient resources and guides to embark on your path to optimal health with confidence and clarity.

Patient Guide

Patient Guide

For your convenience, we provide a detailed patient guide that you can review online at any time. This guide offers insights into what to expect throughout your outpatient surgical journey, addressing any concerns and providing peace of mind.

Download Patient Guide

Essential Patient Resources

Patient Rights and Responsibilities

At RASC, your rights as a patient are our priority. We also inform you of your responsibilities as a patient so that we may provide you with the best care possible.

Privacy Notice

We value your privacy and understand the importance of keeping your records confidential. We also take great measures to protect your identity.

Nondiscrimination Notice

You have a right to safe medical care without discrimination. We also make every effort to ensure you understand your rights and instructions if your first language is not English.

Grievance Policy

We value our patients’ feedback and take complaints very seriously. We make every effort to address our patients’ concerns immediately.

Authorization for Release of Information

Your records remain protected until we receive formal authorization from you to have them released to you or a third party. The process is quick and simple. Complete the ROI form and return to Rockford Ambulatory Surgery Center by mailing it or faxing it to our Medical Record Department. You may also bring the form into our offices.

Frequently Asked Questions

At RASC, we aim to provide clear and helpful answers to your questions.

Financial Information

Facility Fee

Fees associated with the facility such as the use of the center are issued by RASC. Fees from your personal surgeon or anesthesiologist are separate.

The Surgery Center facility fee includes charges for the operating room, recovery room and most other services provided during your stay. The facility fee DOES NOT include professional fees for your Surgeon, Anesthesiologist or Pathologist. These are INDEPENDENT PROFESSIONALS NOT EMPLOYED BY THE SURGERY CENTER.

Please inform us if your insurance policy designates pathology/laboratory services from a specific provider. Special supplies and equipment (lasers, external fixation devices, implants, orthopedic plates and screws) may generate additional charges. CONTACT YOUR INSURANCE COMPANY IN ADVANCE TO VERIFY COVERAGE.

Feel free to contact our patient accounts department if you have any questions regarding our fees.

No Surprise Billing Disclosure

You are protected from what is known as “surprise billing.” This is when you are involuntarily attended by someone who is not considered to be in your insurance provider’s network.


Most insurance companies favor having outpatient surgery at a facility like RASC. Be sure to check with your provider prior to scheduling your procedure for details about coverage.

Most insurance companies and employers favor outpatient surgery. Some tailor reimbursement schedules as an incentive to use outpatient centers. We suggest that you confirm your coverage; always check with your insurance provider. In some instances, you may be asked to pay a portion of any unmet insurance deductible prior to your surgery. If your insurance company determines that your condition is preexisting and denies payment, the entire charge will be your responsibility.

  • AETNA Heath, Inc.
  • The Alliance (Employer Health Care Alliance Cooperative)
  • Beechstreet (Multiplan)
  • BlueCross/BlueShield PPO and HMO/Physicians Care Network (PCN)
  • Choice Care Network (Humana)
  • Corvel Corporation (Core-Care Work Comp)
  • Coventry Health (Personal Care, Note: Swedes employees will be out of network for Tier 1)
  • ECOH/ECOH River Valley
  • Freeport Health Network (through Northern Illinois Health Plans)
  • HFN (Health Care Finest Network)
  • Medicare
  • Medicare Replacement Policies
  • Multiplan
  • One Health PPO/HMO (Great West Insurance)
  • PHCS
  • Preferred Plan Inc. (formerly Benesight)
  • United Healthcare


Taking care of the elderly is part of our facility’s promise. We accept Medicare patients.

Rockford Ambulatory Surgery Center accepts assignment on all Medicare Part B claims. This means we agree to adjust your charges to the Medicare allowed amount. Medicare reimburses 80% of the allowed amount after your Part B deductible has been met. Any remaining deductible and your 20% coinsurance will be billed to one supplemental insurance carrier. If you do not have a supplemental insurance policy, you will be responsible for any deductible and/or coinsurance.

Rockford Ambulatory Surgery Center accepts Medicare Replacement policies; however, we are NOT directly contracted with all of them. Please check with your insurance carrier for possible penalties and benefit reductions before scheduling your surgery.

3 tips for people in the Qualified Medicare Beneficiary Program

If you’re among the 7.5 million people in the Qualified Medicare Beneficiary (QMB) Program, Medicare providers aren’t allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments. If a provider asks you to pay, that’s against the law.

If you get a bill for these charges:

  1. Tell your provider or the debt collector that you’re in the QMB Program and can’t be charged for Medicare deductibles, coinsurance, and copayments. If you’ve already made payments on a bill for services and items Medicare covers, you have the right to a refund.

    Note: To make sure your provider knows you’re in the QMB Program, show both your Medicare and Medicaid or QMB card each time you get care. You can also give your provider a copy of your Medicare Summary Notice (MSN). Your MSN will show you’re in the QMB Program and shouldn’t be billed. Log in to your Medicare.gov account at any time to view your MSN or sign up to get your MSNs electronically.

  2. If your provider won’t stop billing you, call us at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. We can confirm that you’re in the QMB Program. We can also ask your provider to stop billing you, and refund any payments you’ve already made.
  3. If you have a problem with a debt collector, you can send a complaint to the Consumer Financial Protection Bureau (CFPB) online or call the CFPB toll-free at (855) 411-2372. TTY users can call (855) 729-2372. CFPB will forward your complaint to the debt collection company and work to get you a response from them.


CareCredit® is North America's leading patient payment program. It works just like a credit card but is exclusive for healthcare services. It helps cover out-of-pocket expenses.

CareCredit offers low monthly payment options, no up-front costs, no prepayment penalties and no annual fees, it offers a convenient way to finance any balance your insurance company does not cover. It allows you to make monthly payments that easily fit your budget.

Learn More

Workers’ Compensation/Accident-Related Claims

Patients are expected to work with their own legal counsel when addressing workers’ compensation or other similar claims that may be entitled for reimbursement. This includes any invoices that may be issued by RASC.

Rockford Ambulatory Surgery Center is not responsible for any disputed claims. When an accident, liability, workers' compensation or group claim is disputed, the matter is resolved by the patient and the company involved. In such cases, the patient will be requested to pay the bill prior to the claim being resolved. The balance is due within 90 days of any denial.

Collection Policy

As a patient, you accept responsibility for any out-of-pocket expenses you may incur. We offer financing options available to you if you need them.

When you register for services at RASC, you sign a contract with the Center which states that you understand and accept full responsibility to pay for the services rendered by the Center regardless of the type or amount of health insurance. You also consent for us to directly bill your insurance carrier for the covered portion of the charge. If it becomes evident after 90 days that a patient does not intend to satisfy his/her financial obligation to RASC, a collection agency and/or legal action may be implemented to settle the debt. You will be responsible for an additional collection fee of 30%.

Zero Card

Navigate your way to better health with the Zero plan. RASC accepts the Zero Card.

We Thrive on Patient Satisfaction

You may have been invited to fill out a patient satisfaction survey. Please take a moment to leave your feedback if you have not done so already.

What Are Patients Saying About RASC?

The entire staff I had contact with was very professional, yet personable and made sure I was comfortable at all times.
Everyone at RASC made me feel safe, comfortable, and well cared for. I was well informed at every stage of the procedure.

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