Ambulatory surgery center financial assistance policy overview
Our financial assistance program has policies which offer a variety of ways to reduce a patient’s financial responsibility for services rendered by the surgery center. Our program structures a balance between offering the patient a reduced financial liability while still complying with insurance contract obligations and Federal and state regulations. Please contact our surgery center’s business office supervisor for further information on our application process and policies as reflected below. Surgeons, anesthesiologists, and other service providers (such as pathologists or laboratories) bill for their services separately from the surgery center and may offer their own financial assistance program—please contact them for further information regarding their services.
You may request our surgery center to provide details for any of the components of its financial assistance program. Certain policies have an application process requiring the patient to submit additional financial and household income information for verification and to determine qualification of the available assistance. Medicare requires such with respect to Medicare beneficiaries.
Each patient is expected to pay his/her estimated financial liability on or before the day of service. In the event a patient is unable to pay the estimated liability in full, our surgery center may offer a short term repayment schedule after a minimum down payment is made. For an extended repayment schedule, a patient may need to secure financing with an outside source, for which our business office supervisor can provide information.
Patients who are not eligible to receive services paid for by insurance or other third party payment sources may be eligible to receive an uninsured discount from our facility. This discount does not apply for cosmetic surgery services as defined by our facility. The discount is a set percentage off of charges, subject to annual changes, and is similar to our center’s managed care discounts. Certain implants, drugs and high cost supplies may be separately discounted. At the time of service, patients will be asked to make payment in full. If a patient’s services are subsequently found to be covered by insurance or other third party payment source, the uninsured discount may be disallowed.
Prompt pay discount
The center may offer a nominal discount for full payment of the estimated financial liability on or before the day of service for patients with non-government insurance coverage in an effort to reduce its collection expenses. The discount is a set percentage. Should the actual financial liability vary from the estimated liability, the discounted amount will be adjusted in order to maintain the set percentage.
The center offers a charity discount which provides financial relief to patients who receive medically necessary care and who do not qualify for state or Federal assistance, and are unable to pay the estimated or remaining financial responsibility balance in part or in full. In most cases, it will apply to patients who fall between zero and 200 percent of the household Federal Poverty Level Guidelines (revised annually). Patients who meet this qualification and can provide sufficient supporting documentation will have a 100 percent charity discount applied to their account. No charity discount can be applied to any account with any outstanding payer liability.
For Medicare beneficiaries, completion of a Financial Assistance Application (FAA) will be required. Additionally, the preferred income documentation is the most current year’s Federal tax return. Any patient unable to provide his/her most recent Federal tax return may provide two types of supporting documentation from the following list to meet this income verification requirement: State income tax return for the most current year, supporting W-2 and 1099 forms, most recent bank and brokerage statements, or current credit report.
For non-Medicare patients, in addition to the FAA, at least one type of supporting documentation from the list above is requested. If the above-referenced documentation is not available, the following types may be considered: recent employer pay stubs, written documentation from income sources, or bank statements for the most recent three months.
For patients who have a financial liability exceeding $10,000 on procedure services and who have income levels between 201 and 500% of the Federal Poverty Level Guidelines, our surgery center has an expanded financial assistance policy that may reduce the amount owed.
Out of network
A patient receiving treatment at our surgery center under insurance with which our facility is out of network may be eligible to receive an adjustment to their assigned out of network patient liability, assuming our facility is not prohibited from offering Out of Network adjustments under state/Federal laws or your insurance company’s provisions. If not prohibited, the application of any out of network discount is subject to vary based on a patient’s benefit coverage. Accounts which become delinquent may have the adjustment disallowed.
Patients and prospective patients may request from this facility and other health care providers a more personalized estimate of charges and other information. Our surgery center can provide a good faith estimate of charges based on the planned services and items anticipated for your care before your surgery. Additionally, a statement of estimated charges is available upon discharge.
As a courtesy to our patients, we will file an insurance claim on behalf of the patient to his/her insurance plan. A patient is expected to respond to his/her insurance plan’s request for information timely, as needed, in order to minimize processing delays with the claim.
Patients are expected to pay their financial obligations in a timely manner including the estimated portion by the day services are received, and any remaining portion upon finalization of the claim by the payer. Unpaid claims by the payer may result in the account’s outstanding balance being fully transferred to the patient for collection.
If needed, the center will attempt to reach a patient or his/her responsible party by any method available (dunning statements, calls, etc.) to us to secure payment on the outstanding balance utilizing internal and external resources. If the account becomes delinquent, it may be placed with an attorney or agency for collection in which their fees and expenses may be the obligation of the patient.
Florida HealthFinder link
Patients may access the State of Florida’s Agency for Healthcare Administration website at this link for information about this surgery center: www.floridahealthfinder.gov
Information on payments made to the facility for defined bundles of services and procedures is available at Florida Health Finder - Pricing. The service bundle information is a non-personalized estimate of costs that may be incurred by the patient for anticipated services, and actual costs will be based on services actually provided to the patient.
Services may be provided in this health care facility by the facility as well as by other health care providers who may separately bill the patient and who may or may not participate with the same health insurers or health maintenance organizations as the facility.
Patients and prospective patients should contact each health care practitioner who will provide services in our surgery center to determine the health insurers and health maintenance organizations with which the health care practitioner participates as a network provider or preferred provider.
Contracted service providers
As of January 27, 2023, the following providers render services to patients of this surgery center. Patients should contact:
EmCare Anesthesia Services
18167 US Hwy 19N, Suite 650
Clearwater, FL 33764
Office: (727) 637-0733
Fax: (727) 532-1929
This surgery center submits specimens to different pathology providers so please inquire with the facility as to which pathology provider will be used. Some pathology providers may engage specialized pathologists to assist in examining the patient’s specimen.
This surgery center submits specimens to different laboratories so please inquire with the facility as to which one will be used. Some laboratories may engage other labs to assist in analyzing the patient’s specimen.