Delray Beach, FL
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Patient Resources
Financial Assistance Policy Overview
Our financial assistance program offers a variety of ways to reduce a patient’s financial responsibility for services rendered by the surgery center. 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. Please contact our facility’s business office for further information on our policies as reflected below. Surgeons, anesthesiologists, and other service providers (such as pathologists or laboratories) bill for their services separately from the surgery center and may offer their own financial assistance program—please contact them for further information regarding their services.
For payment and billing related questions, please contact us directly at 402-205-2681. All billing related requests will be provided within seven business days.
Application Process
You may request the facility to provide details for any of the elements within the financial assistance program. Certain policies have an application process requiring the patient to submit additional financial and household information to determine qualification of the available assistance.
Price Transparency
A licensed facility shall make available to a patient all records necessary for verification of the accuracy of the patient's statement or bill within 10 business days after the request for such records. The records must be made available in the facility's offices and through electronic means that comply with the Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. s. 1320d, as amended. Such records must be available to the patient before and after payment of the statement or bill. The facility may not charge the patient for making such verification records available; however, the facility may charge its usual fee for providing copies of records as specified in s. 395.3025.
Each facility shall establish a method for reviewing and responding to questions from patients concerning the patient's itemized statement or bill. Such response shall be provided within 7 business days after the date a question is received. If the patient is not satisfied with the response, the facility must provide the patient with the contact information of the agency to which the issue may be sent for review.
59A-5.032(3) Itemized statement or bill. The center shall provide an itemized statement or bill upon request of the patient or the patient's survivor or legal guardian. The itemized statement or bill shall be provided within 7 business days after the patient's discharge or release, or 7 business days after the request, whichever is later. The itemized statement or bill must include:
(a) A description of the individual charges from each department or service area by date, as prescribed in paragraph 395.301(1)(d), F.S.;
(b) Contact information for health care practitioners or medical practice groups that are expected to bill separately based on services provided; and,
(c) The center's contact information for billing questions and disputes.
Payment Plans
Each patient is expected to pay his/her estimated financial liability. In the event a patient is unable to pay their liability in full, our surgery center 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 surgery center’s 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.
Prompt Pay Discount
The center may offer a nominal discount for full payment of the estimated financial liability on or before the day of service for patients with non-government insurance coverage in an effort to reduce its collection expenses. The discount is a set percentage. Should the actual financial liability vary from the estimated liability, the discounted amount will be adjusted in order to maintain the set percentage.
Charity Care
The center maintains a charity discount policy, which provides financial relief to patients who receive medically necessary care and who do not qualify for state or Federal assistance and are unable to pay the estimated or remaining financial responsibility in part or in full. A patient must meet the policy’s household income qualifications, which are based on Federal Poverty Level Guidelines (revised annually). Submission of supporting documentation is required to validate a patient’s qualifying status.
Out of Network
A patient receiving treatment at our surgery center 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. Unpaid claims by the payer may result in the account’s outstanding balance being fully transferred to the patient for collection.
If needed, the center 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 surgery center to determine the health insurers and health maintenance organizations with which the health care practitioner participates as a network provider or preferred provider.
Contracted Service Providers
As of July 1, 2016, the following anesthesiologists render services to patients of this surgery center.
Per Florida law of Section 395.301, F.S. regarding the transparency regulations, the facility is required to list of names, addresses, and phone numbers of health care practitioners and medical practice groups contracted to provide services within the center, grouped by specialty or service and any providers who will bill separately. Patients should contact:
K. Herms Inc.
4932 SW Bimini Cir. North Palm City, FL 34990
810.434.2909
BHS Hospital Services, Inc - Anesthesia Billing
c/o Cognizant Technology Solutions Legal Department
300 Frank W. Burr Blvd., Suite 36, 6th Floor, Teaneck, NJ 07666
1.833.794.1184
Medical Records Request
To make our process quicker and easier, National Spine and Pain Centers network outsources our requests for Medical Records to HealthMark Group. HealthMark Group fulfills all patient requests for personal copies at no charge to the patient. By default, your record will be sent to you via email. A hard copy can be sent if requested.
To Request a Copy of your Medical Records:
Register for an account at https://requestmanager.healthmark-group.com/register
- Once logged in, select "Submit Request" from the menu options and enter all required fields. This will
- provide authorization to HealthMark.
- ·Your medical record request will be processed and a notification will be sent via mail or email once complete and available for download.
If you have any questions, please log in to Request Manager for status updates or to chat with support. You may also contact HealthMark at 800-659-4035 or email: status@healthmark-group.com
Florida Healthfinder
The Florida Agency for Health Care Administration (Agency) launched Florida Health Price Finder, a new health care transparency tool for consumers. Pricing is broken down by state average, national average, and county average, providing Florida residents the opportunity to find the best price for their medical needs. The average amounts paid by insurance plans are based on billions of lines of claims data from three Florida health plans.
The website lists services as “care bundles,” s. A care bundle adds together all of the services that are normally involved in a health care procedure. The bundles are made up of logical “steps” that group costs in a way that makes sense to patients. For example, a person thinking about having surgery needs to know:
Step 1. How much will it cost to visit a doctor and get testing to prepare for surgery?
Step 2. How much will the surgery cost? (Patients need to know the total cost of the surgery, including the hospital or surgery center bill, the doctor’s bill, and other providers who might bill separately.)
Step 3. How much will rehabilitation or physical therapy cost if I need it?
Step 4. How much will my follow-up care cost?
Floridians have been able to use FloridaHealthFinder.gov to look up undiscounted hospital charges, however, this is rarely the amount that individuals or insurance companies are expected to pay. Now, with this new tool, and in conjunction with working with their respective insurance plans, Floridians have the opportunity to get a much better estimate of out-of-pocket costs for specific services.
The service bundle information is a non-personalized estimate of costs that may be incurred by the patient for anticipated services and that actual costs will be based on services actually provided to the patient.
http://pricing.floridahealthfinder.gov
No Surprises Act
Beginning January 1, 2022, patients have a right to an estimate of the cost of services they will receive during a procedure or surgery, called a Good Faith Estimate, and more protection from unexpected, or surprise, bills when they receive care from out-of-network providers at in-network facilities. These protections are part of the Consolidated Appropriations Act of 2021 which includes the No Surprises Act.
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
You’re protected from balance billing for:
Emergency services
If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Additionally, Florida law protects patients with coverage through a Health Maintenance Organization (“HMO”) from balance billing for covered services, including emergency services, when the services are provided by an out-of-network provider.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have these protections:
You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
Generally, your health plan must:
Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
Cover emergency services by out-of-network
Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of
Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.
If you think you’ve been wrongly billed, contact The U.S. Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) or visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
The Florida Department of Financial Services, Division of Consumer Services at 1-877-MY-FL-CFO
The federal phone number for information and complaints is: 1-800-985-3059.