Financial Assistance Policy

If West Florida Surgical Suites believes that you have health insurance and/or HMO coverage(s) that may cover some or all of the Services, West Florida Surgical Suites may initiate contact with them to determine your cost-sharing responsibilities for West Florida Surgical Suites’s bill. You may contact them directly as well for additional information concerning your cost-sharing responsibilities. If West Florida Surgical Suites determines that you have cost-sharing responsibilities for West Florida Surgical Suites’s bill, in accordance with West Florida Surgical Suites’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. West Florida Surgical Suites’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 West Florida Surgical Suites, 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 West Florida Surgical Suites to be “charity care.” There is no formal application process for obtaining “charity care” at West Florida Surgical Suites. West Florida Surgical Suites’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 West Florida Surgical Suites, you can receive a good faith estimate of anticipated charges for the treatment of your condition at West Florida Surgical Suites. This estimate must be provided to you within seven (7) days of the request being received by West Florida Surgical Suites. 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 West Florida Surgical Suites at (813) 870-1000. 

Itemized Bill

Upon request and after discharge from West Florida Surgical Suites we will provide a statement within 7 working days of your request.

Provider Disclosure

Services may be provided in this health care facility by West Florida Surgical Suites 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 West Florida Surgical Suites.  You may request a more personalized estimate of charges from these other health care providers by contacting the health care providers directly. West Florida Surgical Suites may contract with providers for pathology and anesthesiology services; these services are billed separately from West Florida Surgical Suites for their services.  You may contact these providers through their contact information provided below.

West Florida Surgical Suites Providers

The pathology labs we send tissue to for analysis include:

United Digestive Pathology

10 Glenlake Pkwy NE-North Tower Suite 900 Atlanta, Georgia 30328

Uniteddigestive.com (678) 638-6066 ext. 2715 

Patient Health Record

Upon request and after discharge from West Florida Surgical Suites, West Florida Surgical Suites 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.

www.Floridahealthfinder.gov

Patient Complaint or Grievance

To report a complaint or grievance, you can contact the facility Administrator by phone at (813) 870-1000 or by mail at:
West Florida Surgical Suites
1715 N. Westshore Blvd, Suite 190, Tampa, FL 33607