Services Provided by this Surgery Center
Nicklaus Children’s Ambulatory Surgery Center is a state licensed health care facility, providing care when a doctor schedules the procedure here. In billing for your patient care, the Surgery Center has one global fee that encompasses all services and supplies.
Patients (or, if they are minors, their parents) are responsible for payment for their procedure. We accept most major health insurance plans and offer in-network benefits for patients with out-of-network plans. Every insurance plan is different. For an estimate of what your insurance will cover and what will be your responsibility, please contact your insurance carrier directly. If you do not have insurance or need payment arrangements, there are many reputable credit services.
3 to 5 days before your surgery, we will verify eligibility with your insurance carrier and get authorization. We will call to give you an estimate of your co-pay or deposits. You are required to make payment in full before the surgery is performed. Cash, personal check, VISA, MasterCard, Discover Card and American Express are accepted.
At registration on the day of surgery, we ask you to provide your insurance card, address and phone number—information that will be used for billing your insurance within several days following your procedure. Please inform us if there are any changes to your address, employer or insurance, to avoid billing discrepancies.
After we receive your insurance verification, we will issue a statement for any outstanding balances that are your responsibility. The Surgery Center fees include the facility usage, medical supplies, medication, staff and recovery time.
Additional Billing
Your doctor will send you a separate bill for the surgical procedure. You may also receive bills for anesthesia treatment provided by the anesthesiologist, biopsy or lesion removal from the pathology lab, or tests performed by the lab.
Separate Providers
You may also receive services from other health care providers while you are a patient in the surgery center. These providers may bill you separately, and they 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 from whom they will receive care to determine the health insurers and HMOs with which they are a network or preferred provider.
One health care provider who will bill you separately for services is the physician performing your procedure. In addition, if you receive services in this facility from other providers (such as anesthesia, pathology or laboratory for analyzing tissues your physician orders to diagnose your condition), you will also receive their separate billing.
Contact the surgery center’s anesthesia providers to determine if they participate in your health plan:
Children’s Anesthesia Associates
3100 SW 62nd Ave, Miami, FL 33155
305.666.6511 ext 3415
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. Or, you may contact the laboratory directly about whether they participate in your health plan.
Pathology labs used by the surgery center for tissue analysis:
Variety Children’s Hospital (Miami Children’s Hospital Laboratory)
3100 SW 62nd Ave, Miami, FL 33155
305.666.6511 or 786.624.4731
nicklauschildrens.org
Estimate of Charges
The surgery center estimate will be based on the procedure specified by your physician and the insurance information you provide. We will contact your insurer to confirm your eligibility for the procedure, and will then base our estimate on what the insurer tells us it will pay. The procedure your physician actually performs may differ from the initial one planned, based on your medical condition at the time of the procedure. Since we cannot forecast the change, the estimate will be based on the planned procedure as originally 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 or Charity Care
We only schedule procedures at this surgery center by physicians on our medical staff.
If your physician determines that special financial assistance may be warranted and agrees to those financial arrangements for his or her services, you may also be eligible for special financial assistance at the surgery center. If your physician or physician’s office staff have agreed to provide special financial assistance for a procedure in this surgery center, please contact us.
We will require that you complete an application for financial assistance with information about your income and expenses. This allows us to assess your need and qualifications for special financial assistance. Confirmation of eligibility includes verifying your household income through paycheck stubs, payments receipts for mortgage or rent and utilities, last year’s tax filing, and information regarding changes since the last tax filing. We follow the most recent poverty guidelines of the U.S. Department of Health and Human Services.
Collections
Prior to your scheduled procedure when your insurance benefits have been verified, we will call to advise you of your insurance deductible and the co-payment that you will be required to pay. We expect this payment to be paid on the day of your surgery when you register at our admission desk.
If you require special consideration for paying the amount due, you must contact us prior to the date of your planned procedure so we can evaluate your eligibility. You may be eligible to pay your balance monthly over a period of three months. This is based on whether your income and expenses meet criteria of our charity care policy. While you may not meet federal poverty guidelines for charity care, you may qualify for a payment plan if we can verify your income is less than four times the federal poverty level.
If we receive denial of payment from your health insurer or HMO, we will notify you. If we receive payment from your insurer or HMO that is less than projected, we will notify you of additional payment 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 notify us in advance of your scheduled procedure that you have no insurance and will pay cash, you may be eligible to receive up to 50% off your estimated charges. You must attest that you have no insurance and you must pay the full estimated charges in advance. 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 50% discount arrangement being null and void, and full payment will be due.
As a courtesy to our patients, we file insurance claims to the patient’s insurance plan on their behalf. Patients are expected to respond to their insurance plan’s request for information in a timely manner to minimize claim processing delays. Patients are expected to pay their financial obligation in a timely manner, including the estimated portion on or before the day of service and remaining portion once the claim is finalized by their insurance plan. Unpaid claims by the health insurer may result in our transferring the account’s outstanding balance to the patient for payment.
We will attempt to reach patients by any internal or external method available to us to secure payment on outstanding balances. If an account becomes delinquent, it may be placed with an attorney or collection agency, and their fees may also become the obligation of the patient.
Florida Health Care Transparency Act
Patients may access the State of Florida’s Agency for Healthcare Administration website for information about this surgery center’s Fee Schedule and patient rights under the Florida Health Care Transparency Act.: floridahealthfinder.gov/CompareCare/SelectChoice.aspx
Florida Health Price Finder
Florida’s Agency for Health Care Administration provides information about pricing and quality to help Floridians make more informed health care decisions. https://pricing.floridahealthfinder.gov/
The Surgery Center Financial Assistance Program
We offer a variety of ways to reduce a patient’s financial responsibility for services at the surgery center. Our program strikes a balance between offering a reduced financial liability while still complying with insurance contract obligations, and federal and state regulations. Please contact our business office for more information about our policies. Our surgeons, anesthesiologists and other service providers bill for services separately from the surgery center, and may offer their own financial assistance. Please contact them for information.
Our Application Process
You may request details for any components of our financial assistance program, as outlined below. Certain policies have an application process requiring patients to submit additional financial and household information to determine their qualification.
Payment Plans
Patients are expected to pay their estimated financial responsibility on or before the day of service. For patients unable to pay the estimated amount in full, we may offer a short-term repayment schedule once a minimum down payment is made. For an extended repayment schedule, patients may need to obtain financing from an outside source. Please consult with our business office for more information.
Out of Network
Patients with insurance that is out of network for our surgery center may be eligible for adjustment to their assigned and out of network financial responsibility (as long as our center is not prohibited by state of federal laws or the insurer’s provisions). The application of any discount is variable according to the patient’s benefit coverage. Accounts which become delinquent may have the adjustment disallowed.
Other Providers
Patient services in this surgery center may be provided by other health care providers in addition to the facility services. These providers will bill separately for their services, and may or may not participate with the same health insurers or HMOs. Patients and prospective patients may request a more personalized estimate of charges from the surgery center and the other health care providers. They should contact each provider to determine in which health plans they participate as a network or preferred provider.