(813) 783-8242
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Financial Policies

Financial Policy

We may contact you prior to your procedure to discuss your co-payment, co-insurance, or deductible. It is your responsibility to know and understand what your insurance will cover.

General Insurance Information

Your insurance policy is an agreement between you and your insurance company. Our relationship is with you, not your insurance company. Therefore, all charges are ultimately your responsibility, regardless of your insurance status. You are responsible for getting proper referral and pre-authorization information prior to your surgery.

Insurance We Participate With

We will bill your insurance claim for you; however, all co-insurance and/or deductibles are your responsibility. We will estimate the balances to the best of our ability. Payment of this estimate is due on the day of the surgery. For your convenience, we accept Visa, MasterCard, American Express, Discover, Care Credit, Cash, and Checks.

Insurance We Do Not Participate With

We will bill your insurance claim for you, as a courtesy. However, payment of your estimated responsibility is due on the day of your surgery.

Cosmetic & Laser Refractive Surgery

We require that all cosmetic surgery and laser vision correction surgery be paid in full on the date of service.

Workers’ Compensation

We require written approval/authorization by your employer and/or workers’ compensation carrier prior to your surgery. If your claim is denied, you will be responsible for payment in full.

Collection Activity

Any account balance that is not paid within 90 days from the date you were billed by the center may be forwarded to an outside agency for collection follow-up. Any account balance that remains unpaid after this transfer may be eligible for reporting to a credit bureau. Should litigation be necessary to collect an outstanding balance owed, the responsible party agrees to pay all costs of collections, including, but not limited to, collection fees, attorney fees, interest, and court costs.

Payment Plans

The surgery center does not sponsor payment plans. For your convenience, we accept all major credit cards, Care Credit, Cash, and Checks.

Charity

The surgery center works with charity organizations that compensate us for our work. We do not provide free services.

Patient Responsibility Estimate

Any fees collected at the time of service and any quotes regarding such fees are estimated based on the information available to the center at the time of service. The center relies on information provided by the responsible party regarding insurance coverage, information from the responsible party’s insurance company, and procedure fees associated with the CPT codes scheduled/reserved and provided to the center by the patient’s surgeon. There may be additional charges should the surgeon perform a procedure that is different from or in addition to what was scheduled. This quote is only an estimate for the surgical facility fees.
This estimate for surgical facility charges does not include the fees for the:
Physician
Anesthesia
Laboratory
Pathology
Some Implants
These entities may or may not participate with your health insurance. You may request a personalized estimate of charges or any other information needed. Contact information is supplied below.
The Eye Clinic of Florida, Surgeon
6739 Gall Blvd., Zephyrhills, FL, 33542
Anesthesia Management Solutions, CRNA, Anesthesia
6733 Gall Blvd., Zephyrhills, FL, 33542
Laboratory and pathology services are rarely used at our facility. These types of services are usually used in cases of cancers of the eyelid and eyeball. Different labs have different specialties. If you have questions, please ask your surgeon, and the lab or pathologist used can be discussed.

More State-Required Info

Estimate. The center shall provide an estimate upon request of the patient, prospective patient, or legal guardian for nonemergency medical services.
(a) An estimate or an update to a previous estimate shall be provided within seven business days from receipt of the request. Unless the patient requests a more personalized estimate, the estimate may be based on the average payment received for the anticipated service bundle. Every estimate shall include:
  • A statement informing the requestor to contact their health insurer or HMO for anticipated cost-sharing responsibilities,
  • A statement advising the requester that the actual cost may exceed the estimate,
  • The web address to the financial assistance policies, charity care policy, and collection procedure,
  • A description and purpose of any facility fees, if applicable,
  • A statement that services may be provided by other health care providers who may bill separately,
  • A statement, including a web address if different from above, that contact information for health care practitioners and medical practice groups that are expected to bill separately is available on the center’s website; and,
  • A statement advising the requestor that the patient may pay less for the procedure or service at another facility or in another health care setting.
(b) If the center provides a non-personalized estimate, the estimate shall include a statement that a personalized estimate is available upon request.
(c) A personalized estimate must include the charges specific to the patient’s anticipated services. If you have any questions regarding the content of this policy or to request a personalized estimate from Same Day Surgery Center, please contact us at (813) 783-8242.