Welcome!!
Thank you for choosing The Orthopedic Surgery Center of Arizona, TOSCA. We are a physician owned state of the art outpatient surgery center specializing in orthopedics. Our goal is to make your visit as easy, informative and comfortable as possible for you.
With this letter you will find our company brochure which provides you with directions to our facility, an overview of your day at the surgery center, and important information every patient should know prior to surgery. In this letter we would like to point out a few things to help with the process prior to your surgery here at TOSCA, and this form will help you gather some of the information you will need prior to your surgery.
Insurance Process:
Once you have been scheduled at your physician’s office, they will forward your surgery and insurance information to us. We will then verify your benefits for “out-patient surgery for the facility”. Please be aware there will be three (3) providers billing for your surgery: the physician (your doctor), the facility (TOSCA) and anesthesia services (your anesthesiologist). Once we have contacted your insurance company regarding benefits and authorization, you will be contacted within 24-48 hours to review any co-pay, deductible and co-insurance amount due to the facility prior to surgery. Provided on the back of this form is a place to document payments made to your doctor so we can adjust your amount due to the facility and properly reflect your prior payments made (see back of this form). Also, please be advised your payment will be collected prior to surgery, either over the phone or at the time of service prior to services being rendered. We accept all forms of payment, cash, check, all major credit cards and offer financing through Care Credit.
Pre Operative:
As we get closer to your surgery, our Pre Operative department will be calling you to go over medical history and any questions you may have regarding your surgery. We will not be able to provide surgery times or check in time as that is solely up to your physician office; we request you contact your physician if you have any questions regarding your surgery times.
Anesthesia Services:
We recommend contacting our facility regarding which anesthesia company, Metro Anesthesia Consultants or Valley
Anesthesia Consultants, will be scheduled for your surgery. Your physician has a preference as to which company they prefer to work with. We have provided the phone numbers on the back of this page so you can contact the office regarding your visit.
We would be glad to help you regarding any of these areas, or any concerns you may have. Please feel free to contact our office at (602) 424 4408. We look forward to providing you with the best possible care at The Orthopedic Surgery
Center of Arizona for your upcoming surgery.

Paid to my Physician: $_________________ (Deductible paid: $____________)
Is this provider contracted with my insurance?
Spoke with: ________________________ Date: ______/______/_________
TOSCA Amount due: $____________________
((Deductible$______________ Coinsurance $______________ and/or Co-Pay $___________))
Is this provider contracted with my insurance?
YES
Paid Date: _____/_______/ _________
YES
NO
NO
Spoke with: ________________________ Date: ______/______/_________
Anesthesia Company: Metro Anesthesia or
Metro Billing Office (602) 200 9021
Valley Anesthesia Consultants
Valley Billing Office (602) 744 4760
Is this provider contracted with my insurance? YES NO
Spoke with: ________________________ Date: ______/______/_________