PATIENT RIGHTS UNDER FLORIDA TRANSPARENCY ACT OF 2016
Services Provided by Montgomery Eye Center at Center for Sight, L.L.C., a state licensed health care facility.
Montgomery Eye Center at Center For Sight, L.L.C. schedules patient care when your physician schedules a procedure for you at this surgery center. We only schedule procedures at this facility by physicians who are on the medical staff at the facility. The facility has one fee that covers the following items: your physician, anesthesia providers, 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.
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 could include a pathology provider and laboratory which will analyze tissue your physician may require be sent to the laboratory to diagnose your condition.
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:
|Name of pathology lab||Mailing address||Telephone number||Website|
|Naples Pathology Associates||1110 Pine Ridge Rd., Ste. 306, Naples, FL 34108||(239) 263-1777||www.naplespathology.com|
ESTIMATE OF CHARGES
Patient or prospective patients may request from this facility and other health care providers an estimate of charges prior to 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 that you provide to us. 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 offer affordable financing with low monthly payments and accept a variety of payment methods including, but not limited to: financing through Alphaeon Vision (you can apply online at www.centerforsight.net), flexible spending accounts and credit cards (we accept Master Card, Visa and American Express). We also offer an annual charity care program called Mission Cataract. Please visit www.cfsfoundation.org for more information and to see if you qualify for this program.
Prior to your scheduled procedure, we will contact you with the results of the verification of your insurance benefits to advise of your insurance deductible and co-payment amounts that will be due from you prior to your surgery. We expect the amount estimate due to be paid on/or before the day of your surgery.
If you need special consideration for payment of the amount due, you must contact us prior to the date of the planned procedure so we can evaluate your eligibility based on your income and expenses. Please also see “financial assistance arrangements” above.
If we received 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 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 have notified us in advance that you have no insurance and will pay cash for your procedure, 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.
For more information, including quality measures and statistics about our (or any other) facility, please visit www.floridahealthfinder.gov.
Please note: The service bundle information is a non-personalized estimate of costs for anticipated services. Actual costs incurred by the patient will be based on services provided to the patient at the time of admittance.