FINANCIAL POLICY:

Services may be provided by a board-certified physician in this facility as well as other healthcare providers (i.e. anesthesia, pathology) that will bill the patient separately. These providers may not participate with the same health insurers or health maintenance organizations as Suncoast Endoscopy.

Suncoast Endoscopy participates with most insurance plans. All insurance plans have different benefits as well as different financial obligations. Suncoast Endoscopy staff will verify your coverage as best as we can but it is important to note that not all insurance policies cover all services. It is your responsibility to check with your insurance(s) to determine covered benefits; we will assist as best as we can.

**Click here to view what insurances are accepted at our facility.**

**Patient Protections Against Surprise Billing**

SUNCOAST ENDOSCOPY OF SARASOTA FOLLOWS THE FOLLOWING FINANCIAL GUIDELINES:

A copy of your insurance(s) and driver’s license will be taken at each visit to Suncoast Endoscopy.

Previous balances on your account must be paid prior to receiving additional procedures.

Self-pay charges, non-covered charges, coinsurance, copayment, deductible and other amounts for which the patient is responsible, is due at the time of service(s) unless other arrangements have been made in advance with our practice financial counselor. Necessary forms will be completed to help expedite insurance carrier payments.

Uninsured Patients: payment is expected at the time of service(s) for the estimated price of your service(s). A payment plan may be approved under certain circumstances. Major credit cards are accepted ( Visa, Mastercard, Discover, and American Express). When paying with a check or cash there must be an arrangement payment of half of the fee at the time of service and the remainder paid over the following three (3) months. Under certain financial hardship circumstances an alternate payment plan can be arranged.

For dire circumstances, discount and/or charity (hardship) care may be applied for by contacting the Center for more information at 941-952-1145. All information will be kept confidential, except if needed to comply with a court order or legal requirement.

PERSONALIZED ESTIMATE: Patients and prospective patients have a right to request a personalized estimate of charges and other information. Patients and prospective patients should contact each health care practitioner (Physician’s fee, anesthesia provider and pathology) who will provide services in the facility to determine insurance coverage. The requested estimate will be provided to the patient within seven (7) days. The services excluded from the estimated bill would include your Gastroenterologist’s professional fee, anesthesia provider’s fee and pathology services, all of which will be billed to you separately. They may or may not participate with the same health insurers or health maintenance organizations as the facility. Please visit the “ OUR DOCTORS” section of this website to find your physician and his/her office contact information.

ANESTHESIA SERVICES: The anesthesia services at our facility are provided by FDHS Anesthesia, LLC., P.O. Box 73S641, Dallas, TX 75373-5641. You may reach them at 941-304-0157 or 1-888-337-3509. In the event that FDHS Anesthesia, LLC. is not a participating anesthesia provider within your insurance plan, we will work with your insurance company to ensure that you are not penalized for an out-of­ network status. The maximum amount that you will owe will be your participating (in-network) benefit rates. Please contact our office if you have ANY concerns.

PATHOLOGY SERVICES: Our pathology services (polyps or biopsies removed) are provided by Florida Digestive Health Specialists, 10920 Technology Terrace, Lakewood Ranch, FL 34211. The telephone number is 941-757-4820.

SERVICE BUNDLE INFORMATION: The Florida Health Price Finder website located at http://pricing.floridahealthfinder.gov provides estimates of average local, state and national costs for many types of hospital and outpatient procedures. This service bundle information is a non-personalized estimate of costs that may be incurred by the patient for anticipated services. These estimates of average cost are based on paid claims provided by health insurance companies. Your cost will be based on the services actually provided to you, your health plan schedule of benefits and the allowance established by your health insurance plan.

INSURANCE BILLING PROCESS: Suncoast Endoscopy billing is outsourced to Florida Digestive Health Specialists, 10920 Technology Terrace, Lakewood Ranch, FL 34211, 941-757-4820. The facility fee includes the use of the surgery center, supplies, nursing care and equipment use. This billing office will send your claim to your insurance company. After the insurance company pays Suncoast Endoscopy the billing company will send you a statement with any balance due that was not paid upon arrival to our facility. You are bound by the terms of your insurance policy and if you do not follow them, there is a chance they may not pay for all or part of your care. For all questions or concerns relating to your bill or for an itemized statement please call the billing company at 941-757-4820.

COLLECTIONS: Accounts may be turned over to a collection agency if past due ninety ( 90 days). You may be contacted by telephone or text that has been provided to Suncoast Endoscopy. Patients are legally responsible for all collection costs involved with the collection of this account: court costs, reasonable attorney fees and all other expenses incurred with collection if patient’s account is delinquent. The patient is responsible for paying the interest on the full outstanding balance at the maximum rate allowed by law. Interest may be applied to accounts with an outstanding balance after 90 days of non-payment.

CHARITY (HARDSHIP) POLICY: Suncoast Endoscopy provides financial assistance to patients experiencing financial hardship who meet the criteria for government assistance listed on www.benefits.gov. A financial Hardship Declaration form must be completed and submitted with documentation of income. Documentation may include the patient’s most recent federal tax return, twelve (12) months of bank statements or paystubs or unemployment statements for everyone in the household over eighteen (18 ) years of age. If the patient qualifies, we will reduce our rates to the current Medicare allowable rates and collect 50% of the amount at the time of the procedure with the remainder on a payment plan. Click here to download a Financial Hardship Application.