Transparency in Healthcare

Patient Rights Under Florida Transparency Act of 2016

Services Provided by Cypress Surgery Center, a state-licensed health care facility.

Cypress Surgery Center schedules patient care when your physician schedules a procedure for you at this surgery center. The facility has one fee that covers the following items: Nursing, technician and related services; use of the facility; testing for certain lab tests performed at the surgery center just as glucose (blood sugar), pregnancy, and hemoglobin; medications administered before, during and after your surgery while in the facility; surgical supplies used by the physician and staff; equipment used in the facility; surgical dressings; implants except those specifically classified as premium implants that require additional patient payment.

Separate Providers

Services may be provided in this facility by the facility and other health care providers who may separately bill the patient. Those separate health care providers may or may not participate with the same health insurers or health maintenance organizations (HMOs) as this facility. Patients and prospective patients should contact each health care provider who will provide services in the facility to determine the health insurers and HMOs with which the provider participates as a network provider or preferred provider.

Another health care provider who will bill you for services includes your physician performing the procedure. Other providers may bill separately if they provide you with health care services in this surgery center, including an anesthesia provider who delivers anesthesia services to you at the facility and a pathology provider and laboratory that will analyze tissue your physician may require to be sent to the laboratory to diagnose your condition.

You can contact the facility’s anesthesia providers about whether they participate in your health plan. The anesthesia providers are

Name of anesthesia provider group:

Mailing address

Telephone number and Web address:

We may be required to send tissue for analysis by a pathology lab contracted with your health plan. Your insurer’s provider network information may include the pathology lab in the insurer’s network of providers. You may want to check with your insurer. Or, you can contact the laboratory directly about whether they participate in your health plan.

The pathology labs we send tissue to for analysis include:

Quest

4225 E Fowler Ave, Tampa, FL 33617
866-697-8378

LabCorp

5610 W LaSalle St, Tampa, FL 33607
800-845-6167

WCF Laboratory

7920 Woodland Center Blvd, Tampa, FL 33614
813-286-0033 (option 6)

Estimate of Charges

Patient or prospective patients may request from this facility and other health care providers an estimate of charges before receiving services. We must respond to you within seven days of your request.

Our estimate will be based upon the procedure your physician tells us that he or she plans to perform and the insurance information you provide. We normally will contact your insurer to learn of your eligibility for the procedure and will then base our estimate upon what the insurer tells us about the payment they will make for the procedure. The procedure your physician actually performs may differ from the initial one planned based upon your medical condition at the time of the procedure. Since we cannot forecast the change, the estimate will be based upon the planned procedure as scheduled by your physician.

You may pay less or more for this procedure or service at another facility or in another health care setting.

Financial Assistance Arrangements

We only schedule procedures at this facility by physicians who are on the medical staff at the facility. If your physician has determined that special financial assistance may be warranted and the physician agrees to those special financial arrangements for his or her services, you may be eligible for special financial assistance at the facility. If your physician or the physician’s office staff have agreed to provide special financial assistance to you for a procedure the physician wants to schedule at this facility, please contact us. Please be advised that we do not provide full charity care. However, we may provide a reduced fee depending upon your financial assistance needs and our verification of eligibility.

We will require you to complete an application for financial assistance that provides us information about your income and expenses. This will allow us to access your need and qualifications for special financial assistance. Confirmation of eligibility includes verification of your household income through paycheck stubs, receipts for payment of mortgage or rent and utilities, last year’s tax filing, and information regarding changes since the last tax filing occurred. We follow the most recent poverty guidelines set by the U.S. Department of Health and Human Services.

Since these special financial arrangements do not apply to all patients, each patient should request individualized information particular to their financial situation.

Co-insurance or copayment at the time of service may be accomplished through Care Credit – an available program for patients to apply for monthly payments. For information about the Care Credit program go to www.carecredit.com.

Collections

Before your scheduled procedure, we will contact you with the results of the verification of your insurance benefits to advise of your insurance deductible and copayment amounts that will be due from you before your surgery. We expect the amount estimated to be due to be paid on the day of your surgery when you register at our admission desk.

If you need special consideration for payment of the amount due, you must contact us before the date of the planned procedure to evaluate your eligibility.

If we receive a denial of payment from your insurer or Health Maintenance Organization, we will notify you. If we receive payment from your insurer or HMO that is less than projected, we will notify you of the additional amount due. Payment will be expected within 15 days of notification of the balance due. Failure to pay the balance due by the deadline will result in your account being turned over to a collection agency.

If you have notified us in advance that you have no insurance and will pay cash for your procedure, you may be eligible to receive a discount on your estimated charges for payment in advance of the scheduled procedure. You must attest that you have no insurance. If the procedure performed by your physician differs from the one scheduled, you may owe the difference between the scheduled procedure and the actual procedure performed. The balance, if any, will be due within 15 days. Failure to pay the balance will result in the discount arrangement being null and void, and full payment will be due.

Health-Related Data and Pricing

Health-related data, including statistics for defined procedures, can be found on the Agency for Healthcare Administration website at https://www.floridahealthfinder.gov/index.html. The service bundle information is a non-personalized estimate of costs that may be incurred by the patient for anticipated services. The actual cost will be based on services actually provided to the patient. The average pricing for bundled procedures can be found on the Agency for Healthcare Administration website at https://pricing.floridahealthfinder.gov.