PROMENADES SURGERY CENTER LLC
PORT CHARLOTTE, FLORIDA

It is the policy of Promenades Surgery Center, (hereafter referred to as the “Facility”), to collect all copayments, coinsurance and deductibles at or before the time of service. Promenades Surgery Center will inform patients that they may request an estimate of charges for a scheduled procedure. The Facility will admit patients based on the need for services provided by the Facility and will bill patients only for the services and care provided. All patients will be requested to pay for services received. The Facility will inform the patient or prospective patient that he or she may or may not pay less for the services being provided at another facility or in another healthcare setting. Additionally, the patient will be informed that the attending physician who scheduled the patient’s procedure(s) at the facility may or may not be on the medical staff of other such facilities. Patients and prospective patients may request from this facility and other health care providers a more personalized estimate of charges and other information. Patients and prospective patients should contact each health care practitioner who will provide services in the facility to determine the health insurers and health maintenance organizations with which the health care provider participates as a network provider or preferred provider. 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 care insurers or health maintenance organizations as the facility. Due to the nature of our services, Promenades Surgery Center does not routinely provide discounts for uninsured patients. However, in unique cases involving medically necessary services to be delivered to an indigent patient, the management may consider the specific needs of a patient and grant a discount accordingly on a case by case basis individually. Inform the patient or responsible party about the payment policies and the procedure for resolving billing issues upon entry into the system. Inform the patient that services may be provided in this facility by this Facility as well as by other health care providers that may bill separately. During the initial scheduling process, provide patients, upon request, a written good faith estimate of Facility’s anticipated gross charges based on the patient’s procedure(s) as indicated by the physician/surgeon to treat the patient’s condition within seven (7) business days of the request. As with any medical procedure, if unforeseen circumstances should arise during the procedure it may be necessary for the physician to perform additional or different procedures and /or to use more/less expensive supply or implants. The use of implants and /or the difference in procedures may cause the estimate to vary. However, it is understood that final gross charges and patient responsibility will depend on actual services provided and may or may not exceed the original estimate. The estimate of charges being provided to the patient is for the Facility only. If the patient would like a written estimate from other health care providers who will provide services in the Facility, he/she should contact each health care provider as well as asking if they participate as a network provider of preferred provider for that patient or prospective patient’s individual insurance company. When a patient has decided to undergo treatment, verify the patient’s insurance benefits. Notify the patient if a payment is required prior to surgery, and if patient has questions, inform patient to contact their insurance company regarding their coverage and cost-sharing responsibilities i.e. deductibles and co-pays. Prior to or on the day of surgery, before services are provided, it is the Facility policy to collect in full all deductibles, co-insurance and copayments as determined by the patient’s individual insurance company. If the patient is not able to fully pay his/her estimated deductible, co-insurance or copayment at the time of service, Care Credit is available and allows monthly payments to be made. For the application process, go to CareCredit.com. If the patient has no insurance coverage, alternative payment arrangements will be reviewed with the patient. Upon request and after discharge from the facility, the facility will provide a statement within seven (7) business days of patient’s request. Upon request and after discharge, the facility shall make available the patient record that may be necessary for verification of the accuracy of patient’s statement. The patient record will be provided within ten (10) working days of patient’s request. Pursuant to AHCA Statute s.395.3025, F.S. if a copy of a patient record is requested, the facility may charge copy fees. Website © 2016 Promenades Surgery Center Website © 2016 Promenades Surgery Center