Ambulatory Surgery Center Policies

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.

Anesthesiology

Spartan Anesthesia Associates, PA
Denna Ali, MD
Michael A. DiTaranto, MD
Kelly C. Durrett, MD
Marcia M. Rentz, MD
Alain Ruiz, MD
Magdy Sidhom, MD
Steven J. Weiss, MD

2800 Bahia Vista Street
Sarasota, FL 34239
(941) 376-4546

Gastroenterology

Intercoastal Medical Group, Inc.
Jeffrey Gretz, MD
Kinan Rahal, MD
Robert J. Summerlee, MD

943 S. Beneva Road, Suite 306
Sarasota, FL 34232
(941) 955-1108

General Surgery

Intercoastal Medical Group, Inc.
Robert Browning, IV, MD
Richard W. Golub, MD
Joseph Mets, MD
Scott B. Stevens, MD

943 S. Beneva Road, Suite 306
Sarasota, FL 34232
(941) 955-1108

Gynecology

Intercoastal Medical Group, Inc.
Jon Yenari, MD

943 S. Beneva Road, Suite 306
Sarasota, FL 34232
(941) 955-1108

Orthopedic Surgery

Intercoastal Medical Group, Inc.
Michael J. Gordon, MD
Jeffrey M. Oettinger, MD
John C. Thomas, MD

943 S. Beneva Road, Suite 306
Sarasota, FL 34232
(941) 955-1108

Sforzo, Dillingham, Stewart Orthopedics
Christopher L. Dillingham, MD
Christopher R. Sforzo, MD

5831 Bee Ridge Rd., Suite 300
Sarasota, FL 34233
(941) 378-5100

Otolaryngology (ENT)

Intercoastal Medical Group, Inc.
Matthew D. Byers, MD
Christine Cicco-Brown, DO

943 S. Beneva Road, Suite 306
Sarasota, FL 34232
(941) 955-1108

Dr. Roger M. Shea
Roger Shea, MD

5432 Bee Ridge Road, Suite 140
Sarasota, FL 34233
(941) 371-2244

Pain Management

Kennedy-White Orthopaedic Center
Donald L. Erb, DO
Paul S. Satia, MD

6050 Cattleridge Blvd
Sarasota, FL 34232
(941) 365-0655

Ramos Center for Interventional & Functional Pain
Danielle Babb, DO
Fabian A. Ramos, MD

2540 S Tamiami Trail
Sarasota, FL 34239
(941) 213-8752

Podiatry

Intercoastal Medical Group, Inc.
Mark A. Dreyer, DPM

943 S. Beneva Road, Suite 306
Sarasota, FL 34232
(941) 955-1108

Urology

Intercoastal Medical Group, Inc.
Louis H. Cohen, MD

943 S. Beneva Road, Suite 306
Sarasota, FL 34232
(941) 955-1108

Vascular Surgery

Intercoastal Medical Group, Inc.
Ryan S. Suplee, MD

943 S. Beneva Road, Suite 306
Sarasota, FL 34232
(941) 955-1108

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.

  For Florida's regulations on advance directives and advance directive forms, please click here.

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.

The staff of this health care facility recognizes you have rights while a patient receiving medical care. In return, there are responsibilities for certain behavior on your part as the patient. This statement of rights and responsibilities is posted in our facility in at least one location that is used by all patients.

Your rights and responsibilities include:
A patient, patient representative or surrogate has the right to

• Receive information about rights, patient conduct and responsibilities in a language and manner the patient, patient representative or surrogate can understand.
• Be treated with respect, consideration and dignity.
• Be provided appropriate personal privacy.
• Have disclosures and records treated confidentially and be given the opportunity to approve or refuse record release except when release is required by law.
• Be given the opportunity to participate in decisions involving their health care, except when such participation is contraindicated for medical reasons.
• Receive care in a safe setting.
• Be free from all forms of abuse, neglect or harassment.
• Exercise his or her rights without being subject to discrimination or reprisal with impartial access to medical treatment or accommodations, regardless of race, national origin, religion, physical disability, or source of payment.
• Voice complaints and grievances, without reprisal.
• Be provided, to the degree known, complete information concerning diagnosis, evaluation, treatment and know who is providing services and who is responsible for the care. When the patient's medical condition makes it inadvisable or impossible, the information is provided to a person designated by the patient or to a legally authorized person.
• Exercise of rights and respect for property and persons, including the right to
  • Voice grievances regarding treatment or care that is (or fails to be) furnished.
  • Be fully informed about a treatment or procedure and the expected outcome before it is performed.
  • Have a person appointed under State law to act on the patient's behalf if the patient is adjudged incompetent under applicable State health and safety laws by a court of proper jurisdiction. If a State court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with State law may exercise the patient's rights to the extent allowed by State law.
• Refuse treatment to extent permitted by law and be informed of medical consequences of this action.
• Know if medical treatment is for purposes of experimental research and to give his consent or refusal to participate in such experimental research.
• Have the right to change providers if other providers are available.
• A prompt and reasonable response to questions and requests.
• Know what patient support services are available, including whether an interpreter is available if he or she does not speak English.
• Receive, upon request, prior to treatment, a reasonable estimate of charges for medical care and know, upon request and prior to treatment, whether the facility accepts the Medicare assignment rate.
• Receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have charges explained.
• Formulate advance directives and to appoint a surrogate to make health care decisions on his/her behalf to the extent permitted by law and provide a copy to the facility for placement in his/her medical record.
• Know the facility policy on advance directives.
• Be informed of the names of physicians who have ownership in the facility.
• Have properly credentialed and qualified healthcare professionals providing patient care.

A patient, patient representative or surrogate is responsible for

• Providing a responsible adult to transport him/her home from the facility and remain with him/her for 24 hours, unless specifically exempted from this responsibility by his/her provider.
• Providing to the best of his or her knowledge, accurate and complete information about his/her health, present complaints, past illnesses, hospitalizations, any medications, including over-the-counter products and dietary supplements, any allergies or sensitivities, and other matters relating to his or her health.
• Accept personal financial responsibility for any charges not covered by his/her insurance.
• Following the treatment plan recommended by his health care provider.
• Be respectful of all the health providers, and staff, patients, as well as visitors.
• Providing a copy of information that you desire us to know about a durable power of attorney, health care surrogate, or other advance directive.
• His/her actions if he/she refuses treatment or does not follow the health care provider's instructions.
• Reporting unexpected changes in his or her condition to the health care provider.
• Reporting to his health care provider whether he or she comprehends a contemplated course of action and what is expected of him or her.
• Keeping appointments.

COMPLAINTS

Please contact us if you have a question or concern about your rights or responsibilities. You can ask any of our staff to help you contact the Administrative Director at the surgery center. Or, you can call
941-379-5884

We want to provide you with excellent service, including answering your questions and responding to your concerns. 

You may also choose to contact the licensing agency of the state,
Agency for Health Care Administration
2727 Mahan Drive, Tallahassee, FL 32308
1-888-419-3456

If you are covered by Medicare, you may choose to contact the Medicare Ombudsman at 1-800-MEDICARE (1-800-633-4227) or online at https://www.cms.gov/Center/Special-Topic/Ombudsman/Medicare-Beneficiary-Ombudsman-Home

The role of the Medicare Beneficiary Ombudsman is to ensure that Medicare beneficiaries receive the information and help you need to understand your Medicare options and to apply your Medicare rights and protections.