Financial Assistance Policy
If Advanced Surgical Care of Clearwater believes that you have health insurance and/or HMO coverage(s) that may cover some or all of the Services, Advanced Surgical Care of Clearwater may initiate contact with them to determine your cost-sharing responsibilities for Advanced Surgical Care of Clearwater’s bill. You may contact them directly as well for additional information concerning your cost-sharing responsibilities. If Advanced Surgical Care of Clearwater determines that you have cost-sharing responsibilities for Advanced Surgical Care of Clearwater’s bill, in accordance with Advanced Surgical Care of Clearwater’s financial assistance policies, you will be required to pay your cost-sharing responsibilities in full on or before the date that Services are provided. Advanced Surgical Care of Clearwater’s financial assistance policies are that if you are unable to pay your cost-sharing responsibilities in full on or before the date that Services are provided, because you believe you are medically indigent or you are not covered by any health insurance or HMO, then upon request Advanced Surgical Care of Clearwater, in its sole discretion, may offer you a discount on the amount due and/or offer a payment plan. Any such discount is considered by Advanced Surgical Care of Clearwater to be “charity care.” There is no formal application process for obtaining “charity care” at Advanced Surgical Care of Clearwater. Advanced Surgical Care of Clearwater’s standard collection policy is to produce and send one or more bills to patients for their cost sharing amount.
Good Faith Estimate
Upon your request, and before the provision of non-emergency care at Advanced Surgical Care of Clearwater, you can receive a good faith estimate of anticipated charges for the treatment of your condition at Advanced Surgical Care of Clearwater. This estimate must be provided to you within seven (7) days of the request being received by Advanced Surgical Care of Clearwater. You should contact your insurer or health maintenance organization regarding your cost-sharing responsibilities. You may request and obtain a Good Faith Estimate by calling Advanced Surgical Care of Clearwater at (727) 240-2088.
Itemized Bill
Upon request and after discharge from Advanced Surgical Care of Clearwater we will provide a statement within 7 working days of your request.
Provider Disclosure
Services may be provided in this health care facility by Advanced Surgical Care of Clearwater 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 Advanced Surgical Care of Clearwater. You may request a more personalized estimate of charges from these other health care providers by contacting the health care providers directly. Advanced Surgical Care of Clearwater may contract with providers for pathology and anesthesiology services; these services are billed separately from Advanced Surgical Care of Clearwater for their services. You may contact these providers through their contact information provided below.
Advanced Surgical Care of Clearwater Providers
INSERT PROVIDERS
Upon request and after discharge from Advanced Surgical Care of Clearwater, Advanced Surgical Care of Clearwater will make available the patient record that may be necessary for verification of the accuracy of your patient statement within 10 working days of your request.
Link to Healthcare Related Data
Pursuant to AHCA Statute: s.405.05,F.S. please find here a link to data, quality measures, and statistics that are disseminated by AHCA.
Patient Complaint or Grievance
To report a complaint or grievance, you can contact the facility Administrator by phone at (727) 240-2088 or by mail at:
Advanced Surgical Care of Clearwater
93 Park Place Boulevard, Suite 102, Clearwater, FL 33759