Price Transparency

In accordance with Florida law, 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.

Once insurance processing is complete, you will receive a minimum of three statements:

1. from West Florida Medical Center Clinic Ambulatory Surgical Center (ASC) for the facility fees
2. from the physician who performed your procedure and
3. from the anesthesiology provider(s) who provided anesthesia services (if applicable)

Lab, pathology, and implant charges, if applicable, are not included in any estimate we provide to you.

You may pay less for this procedure or service at another facility or in another health care setting; however, there is no guarantee your provider is on staff at these other facilities.

To find and learn about Florida health care facilities and providers in your area, including quality measures and statistics that are disseminated by AHCA pursuant to s408.05 F.S., visit http://www.floridahealthfinder.gov/.

Please see the list of providers associated with West Florida Medical Center Clinic, P.A., Ambulatory Surgery Center here.

Please visit the following link for pricing pursuant to s.395.301 F.S. pricing.floridahealthfinder.gov

On the above link, you can find service bundle information about the costs for your procedure. This information is a non-personalized estimate of costs that may be incurred for your anticipated services. Your actual costs will be based on the specific services provided to you.

Patients and prospective patients may request from this facility and other health care providers a personalized estimate of charges and other information. Patients and prospective patients should contact each health care practitioner who will provide services in the ASC to determine the health insurers and health maintenance organizations with which the health care practitioner participates as a network provider or preferred provider.

You will be contacted prior to your procedure to advise you of your estimated costs due at the time of service. Every attempt will be made to estimate your portion (the portion of charges your insurance will not cover or deems patient responsibility) as closely as possible. This verification will include MCC physician’s surgical fees, facility fees, and any applicable anesthesia fees. You will be given a copy of our estimate on the day of your procedure.

The deposit calculation sheet given on the day of your procedure is strictly an estimated figure. Please be aware that there are many variables which could result in charges being more or less than estimated. The estimated balance is based on your insurance benefits when verified and may vary when insurance is billed.

Amounts collected at the time of service are strictly an estimate, and insurance must process before final patient responsible amounts can be determined.

In the event of any overpayment or credit on your account, signing the deposit calculation authorizes the transfer of the overpayment to any outstanding debt at the Ambulatory Surgery Center and/or Medical Center Clinic.

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

WHAT IS “BALANCE BILLING” (SOMETIMES CALLED “SURPRISE BILLING”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

YOU ARE PROTECTED FROM BALANCE BILLING FOR:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

In general, Florida law prohibits providers from balance billing commercially insured patients for emergency services. Florida has two separate laws that protect PPO and HMO members from balance billing. You should contact your insurer to determine whether you are a PPO or HMO member. HMO Patients: A provider may not collect or attempt to collect payment from a HMO subscriber for any amount that is the responsibility of the HMO. Fla. Stat. § 641.3154. A subscriber’s copayment for emergency services is limited to a reasonable copayment not to exceed $100 per claim. Fla. Stat. §§ 641.513(4), 641.31(12). PPO Patients: For emergency services provided by out-of-network providers and facilities, Florida law prohibits the provider or facility from charging PPO patients for any balance not paid by insurance. Fla. Stat. § 627.64194(5). The PPO patient’s cost sharing amount is limited to the in-network amount.

Certain Services At An In-Network Hospital Or Ambulatory Surgical Center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

In Florida, out-of-network providers who provide non-emergency services at in-network facilities are prohibited from billing PPO patients for any amount beyond their in-network level of cost sharing. Fla. Stat. § 627.64194.

WHEN BALANCE BILLING ISN’T ALLOWED, YOU ALSO HAVE THESE PROTECTIONS:

• You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
• Generally, your health plan must:
  • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
  • Cover emergency services by out-of-network providers.
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
  • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact the Customer Service Department at 850-474-8600; Florida Insurance Consumer Helpline at 1-877-693-5236; the Florida Department of Health at 850-245-4444; or the Agency for Health Care Administration at 888-419-3456.

Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
Visit www.flsenate.gov/laws/statutes for more information about your rights under Florida law.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurancean estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

As of June 2016, the below are medical practice groups and facilities with which Medical Center Clinic ASC contracts to provide services in the facility. Please contact these facilities directly to inquire as to which health insurers and health maintenance organizations participate as network providers or preferred providers.