Financial Assistance Policy Overview

Our financial assistance program offers 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 facility’s business office for further information on our 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.

For payment and billing related questions, please contact us directly at 402-205-2681. All billing related requests will be provided within seven business days.

Application Process

You may request the facility to provide details for any of the elements within the financial assistance program. Certain policies have an application process requiring the patient to submit additional financial and household information to determine qualification of the available assistance.

Payment Plans

Each patient is expected to pay his/her estimated financial liability. In the event a patient is unable to pay their 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. Please consult with our surgery center’s business office for further information.

Uninsured Discounts

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. The discount is a set percentage off of charges and is subject to change. 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.

Charity Care

The center maintains a charity discount policy, 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 in part or in full. A patient must meet the policy’s household income qualifications, which are based on Federal Poverty Level Guidelines (revised annually). Submission of supporting documentation is required to validate a patient’s qualifying status.

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.

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. 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 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.

Other Providers

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 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 this 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

The following anesthesiologists render services to patients of this surgery center. Patients should contact:

Moonlight Anesthesia
PO Box 3090
North Fort Myers, FL 33918

Office phone: 239-217-0376
Fax: 800-507-3974