Ambulatory Surgery Center Policies
At Intercoastal Medical Group, our Ambulatory Surgery Center provides top quality medical care in a warm and comfortable atmosphere. If you or a family member has been referred to the Center for a procedure, please take a few moments to learn about our policies below.
Recognizing the need for patients to understand what is expected regarding payment of medical services, we have established our financial policy. Some of these items are required by law.
- We will help you with the insurance process. We may call you before the procedure regarding your insurance coverage.
- You will be asked to sign an “assignment of benefits” form so that the payment comes directly to our Center. Your co-pay, deductibles, or co-insurance will be collected at the time of admission.
- A more personalized, written estimate of charges and other information will be provided to patients and prospective patients upon request from this facility. Patients and prospective patients should contact each health care practitioner who will provide services in the Ambulatory Surgery Center (ASC) to determine the health insurers and health maintenance organizations with which the health care practitioner participates as a network provider or preferred provider.
- If you have any questions regarding insurance coverage and pre-approval requirements, please call our Business Office at (941) 379-5884.
- Services may be provided in this health care facility by the facility 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 the facility.
- If your doctor should change the scheduled procedure or perform additional procedures, you may be responsible for additional payment.
- All co-pays and co-insurance required by your insurance company must be paid at the time services are rendered. We do not offer any payment plans. We accept cash, checks, Visa, MasterCard, Discover and "pre-approved" Care Credit accounts.
- It is the patient’s responsibility to be aware of the contract benefits of his/her insurance carrier. If your insurance requires referrals/pre-authorization for full benefits to be paid, it is your responsibility to verify that the referrals/pre-authorizations are in place prior to your visit.
- Our facility will file both primary and secondary insurance claims for medical services rendered. Claims for a third insurance contract will not be filed.
- We cannot file claims correctly without accurate information from you. Proof of insurance must be presented at each visit.
- If you do not have insurance, payment in full is expected at the time of service.
- To review quality/cost information about ambulatory surgery centers disseminated by the Agency for Health Care Administration (AHCA), click here: www.Floridahealthfinder.gov
- You will receive a statement from our office within 30 days of your insurance company’s response. If you are dissatisfied with their payment, please contact your insurance carrier. Payment of the patient’s portion of the balance is due upon receipt of the statement.
- We are participating providers for Medicare. This means that we must accept Medicare’s allowed charge for the services rendered. Medicare will pay 80% of the approved amount. The patient is responsible for the remaining 20% plus any out-of-pocket deductibles. We will write off the difference between what we charge and what Medicare approves. If you have secondary insurance, we will submit the claim for the remaining balance after Medicare has paid. Please remember that although we accept assignment for Medicare, the patient by federal law must be held responsible for any portion of the approved amount not paid by Medicare or a secondary insurance company.
- Responsibility for payment for services rendered to the child/children of divorced or separated parents rests with the parent who seeks treatment. Any court ordered judgment must be between the individuals involved, without including our facility.
- All accounts that are 60 days or more past due may be turned over to a collection agency.
- In the unlikely event your payment is returned unpaid, we may elect to re-present your payment to your financial institution up to two more times.
It is our hope that you will find this information helpful. If you have questions, please speak with our billing staff at (941) 379-5884.
Intercoastal Medical Group Business Office
943 S. Beneva Road, Suite 306
Sarasota, FL 34232
Kennedy & White Orthopedics
6050 Cattleridge Blvd.
Sarasota, FL 34232
Dr. Lisa Kelmeyer
5575 Marquesas Circle
Sarasota, FL 34233
Ramos Pain Center
5741 Bee Ridge Road, Suite 550
Sarasota, FL 34233
Dr. Michael Sassaris
3920 Bee Ridge Road, #A, Bldg. C
Sarasota, FL 34233
Florida Orthopedic Specialists
5831 Bee Ridge Road, Suite 200
Sarasota, FL 34233
Dr. Roger Shea
5432 Bee Ridge Road, Suite 140
Sarasota, FL 34233
Spartan Anesthesia Group
2800 Bahia Vista Street
Sarasota, FL 34239
Notice of Privacy Practices
Policy on Advanced Directives
Most procedures done in an ASC setting are considered to be of minimal risk. If an adverse effect occurs during your treatment at this facility, all means of resuscitation or stabilizing measures will be performed and you will be transferred to an acute care hospital for further evaluation.
At the acute care hospital, further treatment or the withdrawal of treatment will be ordered in accordance with your wishes, advance directive, or health care Power of Attorney.
- You can provide the facility with a copy of your advanced directive / living will / health care proxy.
- The Facility does not honor this document
- I agree to proceed with the proposed procedure as scheduled.
- The facility can provide information on how I can obtain an advanced directive / living will / health care proxy.
Your Rights and Responsibilities as a Patient
You have the right to personal privacy and confidentiality of your clinical records, to receive care in a safe setting and be free from all forms of abuse or harassment. You have the responsibility to provide accurate medical and insurance information and to follow the health care facility rules and regulations affecting patient care and conduct.
Your Physician’s Ownership in the Facility
Your physician may have a “beneficial interest” in this surgery center and you have the right to choose another facility in which to receive the services your physician has determined are necessary. Please refer to the Physician Ownership section of this website.
The Submission Process and Handling of Grievances
You have the right to voice any grievances regarding your treatment or care. You can file a grievance with the facility’s appointed representative by calling (941) 379-5884 or through the Office of the Medicare Beneficiary Ombudsman by visiting www.medicare.gov.
This facility and medical staff of Intercoastal Medical Group Ambulatory Surgery Center have adopted the following list of patient rights and responsibilities. This list shall include, but is not limited to:
The patient has the right:
- To impartial treatment without regard to race, color, sex, national origin, religion, handicap or disability
- To exercise his or her rights without being subjected to discrimination or reprisal
- To be free from all forms of abuse or harassment
- To receive considerate and respectful care at all times and under all circumstances
- To know of the name and professional status of those caring for him or her
- To receive information from the physician about his or her diagnosis, treatment plan and prognosis to the best of the physician’s knowledge
- To participate actively in decisions regarding your medical care. To the extent permitted by law, this includes the right to refuse treatment.
- Of full consideration of privacy concerning your medical care program. Case discussion, consultation, examination, and treatment are confidential and should be conducted discretely.
- To be informed that advanced directives cannot be honored in this facility and to be advised that should an unexpected, life-threatening event occur, the patient will be transferred to a facility that will honor their directive
- To confidential treatment of all communications and records pertaining to care. Written permission shall be obtained before medical records can be made available to anyone not directly involved with your care.
- To receive responsible responses to any reasonable requests for service
- To leave the facility even against medical advice
- To expect reasonable continuity of care
- To be advised if the physician proposes to engage or perform experimentation affecting your care or treatment and the right to refuse to participate in the activity
- To be informed of the continuing health care requirements following discharge from the center
- To examine and receive an explanation of a bill for service, regardless of source of payment
- To report any comments concerning the quality of care provided to you and expect follow-up on your comments
The patient is responsible:
- For providing accurate and complete information concerning his present complaints, past medical history, and other matters relating to their health
- For notification of the existence of an advanced directive (as a living will), as those cannot be honored in this facility
- For making it known whether they clearly comprehend the course of their treatment and what is expected of them
- For following the treatment plan established by the physician, including the instructions of nurses and other health care professionals as they carry out the physician’s orders
- For keeping their appointment and notifying the facility if they are unable to do so
- For providing a responsible adult to drive them home and stay with them for 24 hours after surgery
- For providing complete and accurate insurance information (if applicable) and assuring that the financial obligations of their care are fulfilled as promptly as possible
- For being considerate of the rights of other patients and facility personnel