Billing & Insurance

State of Florida Transparency in Health Care Legislation

Our Insurance Providers

AETNA

AETNA MCR PPO

AVMED

BCBS SELECT

BCBS BLUE CARE HMO

BCBS MEDICARE PPO

BCBS MEDICARE ADVANTAGE HMO

BCBS OPTIONS PPO

BCBS FEDERAL

BCBS ANTHEM

CHAMP VA

CIGNA

CAREPLUS

FREEDOM

GHI

GEHA

GREAT WEST

HUMANA PPO

HUMANA HMO

HUMANA MEDICAID

MEDICARE

MEDICAID

STAYWELL

SUNSHINE

OPTIMUM

MEDI SHARE

UHC CHOICE PLUS

UHC THE VILLAGES

UHC AARP MEDICARE COMPLETE

UHC DUAL COMPLETE

UHC MEDICARE ADVANTAGE

UMR

TRICARE STANDARD

TRICARE PRIME

WELLCARE

OSCAR

Billing Disclosure

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

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, such as a copayment, coinsurance, and/or a deductible. You may have other 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” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay 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 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.

You are 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 the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). 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.

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 may 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 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 care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

  • You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
  • Your health plan generally must:
    • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
    • Cover emergency services by out-of-network providers.
    • 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 benefits.
    • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

Many states have specific state laws to determine payments from insurers. Click here to view a list of state-specific information.

If no state law applies or if you think you’ve been wrongly billed, contact the federal regulators responsible for enforcing the federal surprise billing protection laws at 1-800-985-3059.

Visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.

Financial Assistance

All patients have the right to a personalized price estimate to be given by the center. This estimate is reviewed during the pre-registration phone call and available upon request. The centers financial program allows for flexibility while still complying with insurance requirements, federal, and state regulations. To request a price estimate please contact the Surgery Center’s Insurance Verification office at (352) 789-6575. Physicians, anesthesia, and other service providers (such as pathologists or laboratories) bill for their services separately from the Surgery Center of Mid Florida and may offer their own financial assistance programs.

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.

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 including the estimated portion by the day services are received, and any remaining portion upon finalization of the claim by the payer. 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.

Our Location

Notice of Data Security Incident

Surgery Center of Mid Florida (“SCOMF”) regrets to inform you that we have been the victim of a data security incident. An authorized user accessed files on its network that may have included personal information, including the health information, of some of its patients.

On or about February 21, 2024, SCOMF experienced a network encryption event. Upon discovering unusual activity on its networks, SCOMF began an investigation, which involved the assistance of cybersecurity experts, to determine the nature and scope of the incident. The investigation determined unauthorized users were able to access SCOMF’s network through SCOMF’s IT vendor. SCOMF’s IT vendor was hacked first and then the unauthorized user exploited the connection between SCOMF and its vendor’s network to attack SCOMF’s systems directly.

Although there is no evidence that any patient information was accessed as a result of this incident, SCOMF is notifying all patients in an abundance of caution due. Personal information contained on SCOMF’s network varies from individual to individual, but may have included patient demographic information, such as names, address, dates of birth; health information, such as medical history, diagnoses, treatments, dates of service; health insurance information, such as account numbers, insurance policy numbers, billing and claims information; and financial account information, including Social Security numbers.

Although there is no evidence that any patient information was accessed or exfiltrated from SCOMF’s network, SCOMF will be sending written notification to all patients regarding the incident and providing guidance about steps patients can take to further protect their information, should they feel it is appropriate to do so.

SCOMF values your privacy and takes the security of our systems very seriously. As such, we have transferred our business to a different IT vendor and have implemented additional safeguards to improve data security on our web server infrastructure and to prevent recurrence of a similar attack. SCOMF has replaced and enhanced all firewalls and has transitioned all data to a secure, cloud-based electronic health record system and practice management software. SCOMF is also notifying certain federal and state regulators as required by law.

SCOMF is providing a dedicated confidential, toll-free inquiry line at 1-888-974-9414 from 9:00 a.m. to 9:00 p.m. EST, Monday through Friday that patients may contact for additional information.

Surgery Center of Mid Florida deeply regrets any concern or inconvenience this incident may cause. SCOMF continues to evaluate its system to assess and address risks to prevent a similar incident from occurring in the future. 

Contact us now to book an appointment.

Address

1950 SW 18th
Suite 102
Ocala, FL 34471

352-789-6575

msanes@scomf.com