Financial Information - Financial Assistance - Surgical Center of Central Florida

FloridaHealthFinder.gov

Patients may access the State of Florida’s Agency for Healthcare Administration website at this link for information about this facility: www.floridahealthfinder.gov

FINANCIAL POLICY
VIEW AND DOWNLOAD OUR FINANCIAL POLICY FORM Please download the Financial Policy, review, print and sign prior to arriving. Please provide the signed document to the front desk upon arrival.

FLORIDA HEALTH FINDER
Patients may access the State of Florida’s Agency for Healthcare Administration website at this link for information about this surgery center: www.floridahealthfinder.gov

PATIENT RESOURCES ON DEFINED SERVICE BUNDLES AND PROCEDURES
Information on payments made to the facility for defined bundles of services and procedures is available at http://pricing.floridahealthfinder.gov/ . The service bundle information is a non-personalized estimate of costs that may be incurred by the patient for anticipated services, actual costs will be based on services provided to the patient at the time of service.

PERSONALIZED ESTIMATE OF CHARGES
Upon a patient’s request, SCCF and health care providers can provide a more personalized estimate of charges and other information prior to the service, including patients with no insurance. Please note that the payments and payment ranges are an estimate of the cost that may be incurred and your actual cost may vary based on actual services rendered. You may pay less for this procedure or service at another facility or in another health care setting. 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 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. Please see the providers tab on our website for more information on the providers that render services at SCCF.

CHARITY CARE AND FINANCIAL ASSISTANCE POLICY
Charity care is not offered to patients at this time. If you do not have insurance, you are responsible for the payment of all services and fees. Please see our financial assistance programs available.

Our financial assistance program offers a variety of ways to reduce a patient’s financial responsibility for services rendered by the facility. 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.

Payment Plans: Each patient is expected to pay his/her estimated financial liability on or before the day of service. In the event a patient is unable to pay the estimated liability in full, our facility may offer a short term repayment schedule after a minimum down payment is made and a secured credit card is on file for scheduled monthly payments. For an extended repayment schedule, a patient may need to secure financing with an outside source. Please consult with our business office for further information.

Uninsured (self-pay) 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 our usual & customary fee schedule 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.

STATEMENT OF FINANCIAL RESPONSIBILITY
In consideration of medical treatment and services provided to the above named patient, the undersigned unconditionally guarantees payment of the account charges and balance in full to SCCF at discharge of the patient. SCCF will process verified and assigned insurance claims as a courtesy to the patient.

COLLECTION POLICY, PAYMENTS AND PROCEDURES
All uninsured balances or amounts remain payable at discharge. A late payment charge of 1.5% per month (18% per annum) will be charged on any unpaid balance not paid within 90 days of the procedure you receive at SCCF. SCCF’s efforts to collect insurance proceeds do not affect the patient/undersigned’s responsibility for any account balance. If SCCF finds it necessary to refer this account for collection to enforce the obligation of the patient and/or the undersigned party/parties, the patient and/or undersigned agrees to pay any and all additional collection expenses, including SCCF’s reasonable Attorney’s fee. The proper venue for any legal action shall be in Polk County, Florida.

2025 ASC Insurance Plans Accepted

90 DEGREES BENEFITS PLAN
AETNA COVENTRY MEDICARE [ALL LINES] AETNA COMMERCIALPPO/HMO  AETNA BETTER HEALTH/HEALTHY KIDS  AETNA MEDICARE SOLUTIONS HMO/PPO
ALLEGIANCE DISNEY PLANS VIA CIGNA
AMBETTER MARKETPLACE {STARTS WITH U}
AUTO (ALL) AVMED BAYCARE COMMERCIAL NETWORK {IMAGING ONLY w/BAYCARE PCP REFERRAL ON FILE}
BAYCARE PLUS COMPLETE {MCR ADVANTAGE PLAN}  BCBS COMMERCIAL PPO/HMO/FEDERAL and ALL OUT OF STATE BCBS PLANS
BCBS MARKETPLACE MyBlue VMYH Prefix  BCBS MEDICARE PPO/HMO
CAREPLUS  CHAMP VA CHILDRENS MEDICAL SERVICE OPERATED BY SUNSHINE HEALTH MCD
CIGNA HMO/PPO/EPO/POS
CLEAR HEALTH ALLIANCE via SIMPLY
DEVOTED MEDICARE ADVANTAGE PLAN  EVOLUTIONS FIRST HEALTH FLORIDA HEALTH SOLUTIONS
FLORIDA KID CARE VIA SIMPLY  FREEDOM/OPTIMUM/MEDICARE HMO
GALAXY HEALTH
GOLDEN RULE
GREAT WEST VIA CIGNA [ALL PLANS]
GREEN IMAGING
GEHA
HEALTHSCOPE
HERITAGE/LUCENT SOLUTIONS JAIL & COMMERCIAL PLANS HUMANA COMMERCIAL PPO
HUMANA COMMERCIAL HMO  HUMANA MEDICAID  HUMANA MEDICARE PPO
HUMANA MEDICARE HMO
IBA/ INSURANCE BENEFIT ADMINISTRATORS
IMAGINE 360
KIS IMAGING VOUCHER – SCHEDULED WITH KIS FOR VOUCHER
MAILHANDLERS
MEDICAID FULL
MEDICAID SHARE OF COST [IF NOT MET PT TO PAY SELFPAY RATES FOR ALL SVC] MEDICARE TRADITIONAL & RAILROAD
MERITAIN HEALTH COMMERCIAL PLANS VIA AETNA MOLINA MARKETPLACE
MULTIPLAN PHCS POLK HEALTHCARE INDIGENT COMMUNITY PLAN VIA MERITAIN PRIME HEALTH SERVICES – WORK COMP
PRIORITY HEALTH COMMERCIAL/MCR ADVANTAGE SIMPLY MEDICAID AND MEDICARE SOUTHCARE SUNSHINE /FLORIDA HEALTHY KIDS MEDICAID SUNSHINE HEALTH MEDICAID  SUPPLEMENTAL PLANS-SECONDARY TO MEDICARE ALL PLANS ACCEPTED TRICARE PRIME/PCP AUTH REQUIRED, SELECT AND STANDARD
ULTIMATE MEDICAL MCR ADVANTAGE [DO NOT SCHEDULE YET – 11.19.24 CONTRACT LOAD NOT COMPLETE YET]
UMR
UNITED HEALTH CARE COMMUNITY PLAN (MCD)
UNITED HEALTH CARE COMMERCIAL PPO/HMO PLANS
UNITED HEALTH CARE SHARED SERVICES
UNITED HEALTH CARE ALLSAVERS
UNITED HEALTH CARE SUREST
UNITED HEALTHCARE DUAL COMPLETE PLAN/DSNP
UNITED HEALTHCARE MEDICAID {CHIP/CHILDRENS HEALTH INS PLAN}
UNITED HEALTHCARE AARP MEDICARE COMPLETE PPO/HMO/FOCUS
UNITED HEALTHCARE STUDENT SERVICES
US HEALTH GROUP
VACCN OPTUM/ VETERANS ADMINI {AUTH REQUIRED BY VA TO SCHEDULE}
WECARE OF CENTRAL FLORIDA [VOUCHER PROGRAM] WELLCARE MEDICARE ADVANTAGE WELLMED UHC MEDICARE ADVANTAGE  WORKERS COMP [ALL PLANS WITH PRIOR AUTHORIZATION REQUIRED FROM ADJUSTER]
ALL PPO PLANS WITH OUT OF NETWORK BENEFITS AVAILABLE

Payment Plans

Each patient is expected to pay his/her estimated financial liability on or before the day of service. In the event a patient is unable to pay the estimated liability in full, our facility 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 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.

Out of Network

A patient receiving treatment at our facility 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 including the estimated portion by the day services are received, and any remaining portion upon finalization of the claim by the payer. Unpaid claims by the payer may result in the account’s outstanding balance being fully transferred to the patient for collection.

If needed, the institute 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 facility to determine the health insurers and health maintenance organizations with which the health care practitioner participates as a network provider or preferred provider.