There are a number of separate charges associated with your surgical procedure. You MAY receive charges from several companies.
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 whom may not participate with the same health insurers or health maintenance organizations as the facility as applicable.
You may pay less for this procedure or service at another facility or in another health care setting. There is no guarantee your health care provider is credentialed or on staff at these other facilities. Full payment of your estimated financial responsibility is due at the time of service. Any potential remaining balance once your insurance has processed the claim will be due within 60 days of notification. Please contact your insurance company directly if you experience any delays. YOU are responsible for guaranteeing payment on your account and being aware of your individual policy restrictions and benefits. Your insurance company, including Worker's Compensation, auto (no fault) and personal injury, is legally responsible to you. Our relationship is with you, our patient, not your insurance company. Consequently, all charges incurred are your responsibility. The obligation to assure payment in a timely manner lies with you regardless of what your insurance company chooses to do. You should normally receive a response from your insurance company within 30 days of your date of service. If you experience a delay, it is expected that you contact your insurance company to check the status of your claim and to expedite payment. Please call our Business Office at 239-689-7000 if you encounter a problem with your insurance company and need our assistance. Gladiolus Surgery Center's policy is to turn over to an attorney or collection agency all accounts which are delinquent. You will be responsible for any collection fees that are incurred.
THE Gladiolus Surgery Center WILL BILL AS FOLLOWS: PRIVATE INSURANCE You will be responsible for any copay, co-insurance and/or un-met deductible amount on or before your date of service. We will submit your bill directly to your private insurance company and any secondary insurance you may have. A bill will be sent to you for any balance after receipt of payment or denial from your insurance companies. We must make a copy of each insurance card at the time of registration. SELF PAY and COSMETIC SURGERY You will be contacted prior to your surgery with an estimated procedure cost for your surgery. Payment is due on or before your surgical visit. You will be asked to complete a financial agreement. ________________________________________
NOTICE TO PATIENTS
Chapter 59A-5.0065 require that each ambulatory surgical center shall develop and adopt policies and procedures to ensure the protection of patients’ rights. A notice of the “Patient’s Bill of Rights” is posted in the waiting room. If you have any complaints which arise one of these rights for Outpatient Surgery maintains a grievance mechanism to resolve them. If you have a complaint you may request a written response. The individual to whom you should address a grievance is:
Lorraine Ambrose, Administrator, CEO 7431 Gladiolus DriveFort Myers, FL 33908239-689-7000Lorraine.firstname.lastname@example.org
7431 Gladiolus Dr
Fort Myers, FL 33908