I. Financial Assistance

a. Contact the Business Office to schedule a financial assistance appointment.

• i. Insurance Coverage Determination:
  1. Yes, insurance coverage is available:
     • a. Business Office will complete benefit check.
     • b. Business Office will advise patient how to contact their plan and obtain estimated patient responsibility.
     • c. See Item III for patient responsibility payment plan.
  2. No, there is no insurance coverage available:
     • a. Complete a financial assessment form with the Business Office.
       1. i. If patient qualifies for charity care:
          • 1. Enrollment assistance offered for Medicaid or Health Insurance Exchange, if applicable.
          • 2. See Item V for Charity Care Policy.
       2. ii. If patient does not qualify for charity care:
          • 1. Advise of full patient responsibility.
          • 2. See Item III for payment plan.

II. Application Process

All applicability of allowable financial arrangements are based on a standardized financial assessment form to be completed by the patient with assistance from the Business Office.

• a. Contact the Business Office to arrange a financial assessment.
• b. The Business Office will evaluate and provide options based on information obtained during the financial assessment. See Item I.

III. Payment Plans

Payment options exist for patients’ financial responsibility that may be negotiated based on the financial assessment form.

• a. If insured, upon request, deductible, co-pays, and co-insurance payment plans can be discussed, as applicable, based on the outcome of your financial assessment.
• b. If uninsured, and not qualified for charity care, payment plan options will be presented.
• c. If qualified for charity care, this process is not applicable.

IV. Discounts

There are no standard discounts. Individual payment plans may include cost reductions.

V. Charity Care Policy

When an uninsured patient falls below certain income levels, which is identified through the financial assessment, services provided are considered charity care and recorded as such. No charges are billed to the patient.

• a. A financial assessment must be completed with the Business Office.
• b. The Business Office will advise patient if charity care criteria have been met.
• c. Enrollment assistance offered for Medicaid or Health Insurance Exchange, if applicable.

VI. Collections Procedure

Payments can be made through various tender. Due dates are discussed during payment plan arrangements. Significantly delinquent accounts will be reviewed for potential placement with a third-party agency.

1. Services may be provided in the hospital by the facility as well as by other health care practitioners who may separately bill the patient;

2. Health care practitioners who provide services in the hospital may or may not participate with the same health insurers or health maintenance organizations as the hospital; and

3. Prospective patients should contact the health care practitioner who will provide services in the hospital to determine which health insurers and health maintenance organizations the practitioner participates in as a network provider or preferred provider.

4. You or your insurance company may receive a separate bill in addition to the hospital’s bill for any of the following services you may receive while at the hospital: your attending physician (including your attending psychiatrist), consults or second opinions ordered by your attending physician, internal medicine physician, anesthesiologist, and ambulance services.

5. Estimated Charges are available upon request. To request an individualized estimate of charges, itemized copy of your bill or medical records to very your bill please call (352) 596-4306 and request to speak to the Business Office Monday through Friday 8:30 a.m. – 5:00 p.m. Patients and prospective patients have a right to request a personalized estimate.

6. This is the link to the AHCA pricing website. https://pricing.floridahealthfinder.gov
The service bundle information is a non-personalized estimate of costs that may be incurred by the patient for anticipated services and actual costs will be based on services actually provided to the patient.