Financial Assistance Policy
If Safety Harbor Surgery Center believes that you have health insurance and/or HMO coverage(s) that may cover some or all of the Services, Safety Harbor Surgery Center may initiate contact with them to determine your cost-sharing responsibilities for Safety Harbor Surgery Center’s bill. You may contact them directly as well for additional information concerning your cost-sharing responsibilities. If Safety Harbor Surgery Center determines that you have cost-sharing responsibilities for Safety Harbor Surgery Center’s bill, in accordance with Safety Harbor Surgery Center’s financial assistance policies, you will be required to pay your cost-sharing responsibilities in full on or before the date that Services are provided. Safety Harbor Surgery Center’s financial assistance policies are that if you are unable to pay your cost-sharing responsibilities in full on or before the date that Services are provided, because you believe you are medically indigent or you are not covered by any health insurance or HMO, then upon request Safety Harbor Surgery Center, in its sole discretion, may offer you a discount on the amount due and/or offer a payment plan. Any such discount is considered by Safety Harbor Surgery Center to be “charity care.” There is no formal application process for obtaining “charity care” at Safety Harbor Surgery Center. Safety Harbor Surgery Center’s standard collection policy is to produce and send one or more bills to patients for their cost sharing amount.
Good Faith Estimate
Upon your request, and before the provision of non-emergency care at Safety Harbor Surgery Center, you can receive a good faith estimate of anticipated charges for the treatment of your condition at Safety Harbor Surgery Center. This estimate must be provided to you within seven (7) days of the request being received by Safety Harbor Surgery Center. You should contact your insurer or health maintenance organization regarding your cost-sharing responsibilities. You may request and obtain a Good Faith Estimate by calling Safety Harbor Surgery Center at 727-787-3000.
Itemized Bill
Upon request and after discharge from Safety Harbor Surgery Center we will provide a statement within 7 working days of your request.
Provider Disclosure
Services may be provided in this health care facility by Safety Harbor Surgery Center 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 Safety Harbor Surgery Center. You may request a more personalized estimate of charges from these other health care providers by contacting the health care providers directly. Safety Harbor Surgery Center may contract with providers for pathology and anesthesiology services; these services are billed separately from Safety Harbor Surgery Center for their services. You may contact these providers through their contact information provided below.
Safety Harbor Surgery Center Providers
Anesthesia Management Solutions
PO Box 919473
Orlando, FL 32891-9473
Tel: 877-822-6281
Fax: 941-358-9818
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:
West Central Pathology
3901 66th St. North, Suite 202
St. Petersburg, FL 33709
727-345-8519
GI Path
3495 Hacks Cross Rd
Memphis, TN 38125
812-259-4089
Interpace
300 Interpace Parkway
Parsipanny, NJ 07054
843-906-2521
Patient Health Record
Upon request and after discharge from Safety Harbor Surgery Center, Safety Harbor Surgery Center will make available the patient record that may be necessary for verification of the accuracy of your patient statement within 10 working days of your request.
Link to Healthcare Related Data
Pursuant to AHCA Statute: s.405.05,F.S. please find here a link to data, quality measures, and statistics that are disseminated by AHCA.
Patient Complaint or Grievance
To report a complaint or grievance, you can contact the facility Administrator by phone at 727-787-3000 or by mail at:
Safety Harbor Surgery Center
3280 N. McMullen Booth Road Suite 110 Clearwater, Florida 33761