Financial Assistance Policy

If FACILITY NAME believes that you have health insurance and/or HMO coverage(s) that may cover some or all of the Services, FACILITY NAME may initiate contact with them to determine your cost-sharing responsibilities for FACILITY NAME’s bill. You may contact them directly as well for additional information concerning your cost-sharing responsibilities. If FACILITY NAME determines that you have cost-sharing responsibilities for FACILITY NAME’s bill, in accordance with FACILITY NAME’s financial assistance policies, you will be required to pay your cost-sharing responsibilities in full on or before the date that Services are provided. FACILITY NAME’s financial assistance policies are that if you are unable to pay your cost-sharing responsibilities in full on or before the date that Services are provided, because you believe you are medically indigent or you are not covered by any health insurance or HMO, then upon request FACILITY NAME, in its sole discretion, may offer you a discount on the amount due and/or offer a payment plan. Any such discount is considered by FACILITY NAME to be “charity care.” There is no formal application process for obtaining “charity care” at FACILITY NAME. FACILITY NAME’s standard collection policy is to produce and send one or more bills to patients for their cost sharing amount.

Good Faith Estimate

Upon your request, and before the provision of non-emergency care at FACILITY NAME, you can receive a good faith estimate of anticipated charges for the treatment of your condition at FACILITY NAME. This estimate must be provided to you within seven (7) days of the request being received by FACILITY NAME. You should contact your insurer or health maintenance organization regarding your cost-sharing responsibilities. You may request and obtain a Good Faith Estimate by calling FACILITY NAME at 239-424-6000. 

Itemized Bill

Upon request and after discharge from FACILITY NAME we will provide a statement within 7 working days of your request. 

Provider Disclosure

Services may be provided in this health care facility by FACILITY NAME 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 FACILITY NAME.  You may request a more personalized estimate of charges from these other health care providers by contacting the health care providers directly. FACILITY NAME may contract with providers for pathology and anesthesiology services; these services are billed separately from FACILITY NAME for their services.  You may contact these providers through their contact information provided below.

FACILITY NAME Providers

CRH Anesthesia of Florida
1-800-660-2153
227 Bellevue Way NE, #188
Bellevue WA 98004

Ameripath Southwest Florida
239-275-1164
1620 Medical Lane, #100
Fort Myers, Fl. 33907

Patient Health Record

Upon request and after discharge from FACILITY NAME, FACILITY NAME will make available the patient record that may be necessary for verification of the accuracy of your patient statement within 10 working days of your request.

Link to Healthcare Related Data

Pursuant to AHCA Statute: s.405.05,F.S. please find here a link to data, quality measures, and statistics that are disseminated by AHCA.

www.Floridahealthfinder.gov