Consent Form

FINANCIAL INFORMATION

CHARGES:
Charges for Gateway Surgery Center and your Physician are separate. The facility (Gateway Surgery Center) charges include the use of the operating / procedure room, nursing staff, medications and most supplies. Your surgeon, anesthesiologist, certiļ¬ed nurse anesthetist, radiologist and pathologist (if applicable) will bill you separately for their services.

CONTACTING OUR INSURANCE DEPARTMENT:

  • Insurance Verification - 704-920-7089
  • Gateway Patient Accounts - 704-920-7045
  • Anesthesiologist - NE Anesthesia - 704-920-1430
  • Certified Nurse Anesthesiologist - Gateway Anesthesia 1-888-278-4126
  • Radiologist - CMC-NE - 704-403-1729
  • Pathologist - CME - NE - 704-403-1542

FINANCIAL AGREEMENT, ASSIGNMENT OF BENEFITS AND RELEASE OF RECORD(S)

 

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