Patient Rights Under Florida Transparency Act of 2016

 

Services Provided by Alliance Specialty Surgical Center, a state licensed health care facility.

 

ASC schedules patient care when your physician schedules a procedure for you at this surgery center.  The facility has one fee that covers the following items: Nursing, technician and related services; use of the facility; testing for certain lab tests performed at the surgery center such as glucose (blood sugar), pregnancy, and hemoglobin; medications administered before, during and after your surgery while in the facility; surgical supplies used by the physician and staff; equipment used in the facility; surgical dressings; implants except those specifically classified as premium implants that require additional patient payment.

               

Health Related Data and Pricing

 

Information on average pricing for bundled procedures can be found on the Agency for Healthcare Administration website at http://pricing.floridahealthfinder.gov     

 

Health related data, including quality measures and statistics for defined procedures can be found on the Agency for Healthcare Administration website at http://www.floridahealthfinder.gov/index.html

 

 

Separate Providers

 

Services may be provided in this facility by the facility as well as by other health care providers who may separately bill the patient. Those separate health care providers may or may not participate with the same health insurers or health maintenance organizations (HMOs) as this facility. Patients and prospective patients should contact each health care provider who will provide services in the facility to determine the health insurers and HMOs with which the provider participates as a network provider or preferred provider.

 

Another health care provider who will bill you for services includes your physician performing the procedure. Other providers who will bill separately if they provide you with health care services in this surgery center include an anesthesia provider who delivers anesthesia services to you at the facility and a pathology provider and laboratory which will analyze tissue your physician may require be sent to the laboratory to diagnose your condition.

 

You can contact the facility’s anesthesia providers about whether they participate in your health plan.  The anesthesia providers are:

Northstar Anesthesia

1-800-930-6313

Email address: PatientBilling@ArietisHealth.com 

 

We may be required to send tissue for analysis by a pathology lab not contracted with your health plan.  Your insurer’s provider network information may include the pathology lab in the insurer’s network of providers. You may want to check with your insurer, or you can contact the laboratory directly about whether they participate in your health plan.

 The pathology labs we send tissue to for analysis include:

  Quest Diagnostics 

1-866-697-8378

Website: www.questdiagnostics.com

               

Estimate of Charges

 

Patient or prospective patients may request from this facility and other health care providers an estimate of charges prior to receiving services. We must respond to you within seven days of your request. 

 

Our estimate will be based upon the procedure your physician tells us that he or she plans to perform and the insurance information that you provide to us. We normally will contact your insurer to learn of your eligibility for the procedure and will then base our estimate upon what the insurer tells us about the payment they will make for the procedure.  The procedure your physician actually performs may differ from the initial one planned based upon your medical condition at the time of the procedure.  Since we cannot forecast the change, the estimate will be based upon the planned procedure as scheduled by your physician.

 

You may pay less or more for this procedure or service at another facility or in another health care setting.

 

Financial Arrangements

 

Prior to your scheduled procedure, we will contact you with the results of the verification of your insurance benefits to advise of your insurance deductible and co-payment amounts that will be due from you prior to your surgery. We expect the amount estimated due to be paid on the day of your surgery when you register at our admission desk.

 

If you need special consideration for payment of the amount due, you must contact us prior to the date of the planned procedure so we can evaluate your eligibility. You may be eligible to pay your balance monthly over a period of three months.

               

If you have notified us in advance that you have no insurance and will pay cash for your procedure, you may be eligible to receive a discount on your estimated charges for payment in advance of the scheduled procedure. You must attest that you have no insurance. If the procedure performed by your physician differs from the one scheduled, you may owe the difference between the scheduled procedure and the actual procedure performed. The balance, if any, will be due within 15 days. Failure to pay the balance will result in the discount arrangement being null and void and a full payment will be due.

 

Charity Care Policy

 

This facility does not have a charity program or policy in place.

 

Collection Procedures

 

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.

 If needed, the center will attempt to reach a patient by any method available 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. 

 For any billing questions please call 386-457-7114 and select the option for billing.

 

List of Our Providers Clinic Main Line 386-274-2977   Dr. Vinod Malik, MD	Dr. Sanjay Bakshi, MD
Dr. Kavita Sharma, DO	Dr. Arun Joseph, MD
Dr. Tse C. Lee, MD	Dr. Rathi Joseph, DO
Dr. Rabinder Bhatti, DO	Dr. Quyen Van Truong, MD
Dr. Himabindu Gandam, MD	Dr. Carl A. Tandatnik, MD