Financial Information
Financial Information
We strictly follow the most up-to-date guidelines, regarding making information about our facility easily accessible, outlined by AHCA. We want all of our patients to feel informed.
Services may be provided in this health care facility by the facility as well as 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.
Patients and prospective patients may request from this facility and other health care providers a more personalized estimate of charges and other information. Patients and prospective patients should contact each health care practitioner who will provide services in the ASC to determine the health insurers and health maintenance organizations with which the health care practitioner participates as a network provider or preferred provider.
Additional information regarding health care quality measures and statistics provided by the State of Florida Agency for Health Care Administration can be found at www.Floridahealthfinder.gov
Pricing Transparency
Service bundle information is a non-personalized estimate of cost that may be incurred by the patient for anticipated services. Actual costs will be based on services actually provided to the patient. It is your right to request a personalized estimate from the center. Please reach out directly to the center on our policies on financial assistance, charity care, and collections procedures.
https://pricing.floridahealthfinder.gov/#
Please contact health care practitioners anticipated to provide services to the patient while in the center regarding a personalized estimate, billing practices and participation with patient’s insurance provider or health maintenance organization (HMO) as the practitioners may not participate with the same health insurers or HMO as the center.
Our Criteria
All outpatient accounts are eligible for uncompensated care consideration. A Charity Care Application must be filled out by the patient/guarantor. Eligibility is based on income, family size and cash assets.
- Patients with current Medicaid benefits having a procedure not covered by Medicaid, and not cosmetic in nature, will be approved for charity care based on their qualification under the Medicaid program. Proof of current Medicaid eligibility will be verified prior to approval.
- Patients at 150% or less of the current Federal Poverty Income level, from all sources, will qualify for Charity Care with completed application.
- Patients at 151% or higher will be considered for Charity Care on a case by case basis with completed application.
Charity Care Policy
The Florida Specialty Surgery Center is committed to providing quality health care to every patient in the Pinellas County area regardless of their ability to pay. Our Charity Care Policy is established to provide financial relief to those who cannot meet their financial obligation to our facility.
Our charity care applies to charges for traditional, non-elective healthcare services to patients meeting the financial criteria set by our surgery center suing the Federal Poverty Income Guidelines found at: https://aspe.hhs.gov/poverty-guidelines.
Financial Hardship Application
COMING SOON
Good Faith Estimate
Upon your request, and before the provision of non-emergency care at Florida Specialty Surgery Center, you can receive a good faith estimate of anticipated charges for the treatment of your condition at Florida Specialty Surgery Center. This estimate must be provided to you within seven (7) days of the request being received by Florida Specialty 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 Florida Specialty Surgery Center at 727-548-6100.
Itemized Bill
Upon request and after discharge from Florida Specialty Surgery Center we will provide a statement within 7 working days of your request, barring any unusual circumstances.
Provider Disclosure
Services may be provided in this health care facility by Florida Specialty 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 Florida Specialty Surgery Center. You may request a more personalized estimate of charges from these other health care providers by contacting the health care providers directly. Florida Specialty Surgery Center may contract with providers for pathology and anesthesiology services; these services are billed separately from Florida Specialty Surgery Center for their services. You may contact these providers through their contact information provided below.
Florida Specialty Surgery Center’s Providers
Tampa Bay Anesthesia
6321 54th Avenue North
St. Petersburg, FL 33709
727-548-5100 Ext.203
Billing/Regulatory
Billing/ Facility Charges and Average Reimbursement
Regulatory
Patients and prospective patients may request from the facility and other health care providers, a more personalized estimate of charges and other information. Patients should contact each health care practitioner who will provide services at ASC to determine the health insurers and health maintenance organizations with which the health care practitioner participates as a network provider or preferred provider.
For more information, feel free to contact us at 727-548-6100
Health-related data, including quality measures and statistics that are disseminated by the agency pursuant to s.408.05
http://www.ahca.myflorida.com
Billing
CPT - Procedure Description - Facility Charges - Facility Reimbursements
G0260 Injection, sacroiliac joint, $3,032.40 $303.24
20610 Drain/inject major joint or bursa $316.80 $31.68
20611 Drain/inject major joint or bursa w/ultsou $544.40 $54.44
27096 Injection, sacroiliac joint $3,032.40 $303.24
62321 Inject, spine, cervical/thoracic $3,032.40 $303.24
62321 Inject, spine, lumbar/sacral $3,032.40 $303.24
63650 Implant epidural neuroelectrodes $10,000.00 $4,230.02
63685 Inplant spinal neuroreceiver $80,000.00 $22,595.38
64420 Inject nerve block, intercostal $3,032.40 $303.24
64447 Inject nerve block, femoral, single $478.40 $47.84
64450 Inject nerve block, peripheral $478.40 $47.84
64483 Inject foramin, lumb/sacral, single $3,930.20 $393.02
64484 Inject foramin, lumb/sacral, ea add $0.00 $0.00
64490 Inject paravert, cerv/thor, 1 level $3,930.20 $393.02
64491 Inject paravert, cerv/thor, 2nd level $0.00 $0.00
64492 Inject paravert, cerv/thor, 3+ levels $0.00 $0.00
64493 Inject paravert, lumb/sacral, 1 level $3,930.20 $393.02
64494 Inject paravert, lumb/sacral, 2nd level $0.00 $0.00
64495 Inject paravert, lumb/sacral, 3+ levels $0.00 $0.00
64510 Inject nerve block, cerv sympathetic $3,930.20 $393.02
64520 Inject nerve block, vert sympathetic $3,930.20 $393.02
64555 Percu implnt neurelecd,peripheral $45,230.40 $4,523.04
64633 Destroy paravert nrv cerv/thor sngl $7,609.80 $760.98
64634 Destroy paravert nrv cerv/thor, add $0.00 $0.00
64635 Destroy paravert nerv lumb/sac sngl $7,609.80 $760.98
64636 Destroy paravert nerv lumb/sac, add $0.00 $0.00
64640 Destroy w/neurlytc oth periphrl nrv $1,762.00 $176.20
64454 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GENICULAR NERVE BRANCHES, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED $1,613.60 $161.36
64624 Genicular RFA $7,609.80 $760.98
64525 RADIOFREQUENCY ABLATION, NERVES INNERVATING THE SACROILIAC JOINT, WITH IMAGE GUIDANCE $7,609.80 $760.98
Language Services
Attention: If you speak one of the following languages, assistance is available to you free of charge. Please ask for assistance from a staff member.
Spanish: Atención: Si hablas uno de los siguientes idiomas, asistencia está disponible para usted de forma gratuita. Por favor pida ayuda a un miembro del personal.
French Creole: Koute: Si w pale yonn nan lang sa yo, asistans disponib pou ou pa bezwen peye pri. Souple mande pou asistans nan yon manm pèsonèl la.
Vietnamese: Chú ý: Nếu bạn nói một trong các ngôn ngữ sau, hỗ trợ có sẵn cho bạn miễn phí. Hãy yêu cầu để được giúp đỡ từ một nhân viên.
Portuguege: Atenção: Se você fala de um dos seguintes idiomas, assistência está disponível a você gratuitamente. Por favor, pedi a ajuda de um membro do pessoal.
Chinese: 注意︰ 如果你說話以下語言之一,援助是提供給你免費。 請從一名工作人員尋求説明。
French: ATTENTION : Si vous parlez une des langues suivantes, une assistance est disponible pour vous gratuitement. S’il vous plaît, demander de l’aide d’un membre du personnel.
Tagalog: Paunawa: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.
Russian: Внимание: Если вы говорите на одном из следующих языков, помощь предоставляется вам бесплатно. Пожалуйста попросите помощь от сотрудника.
Arabic: تنبيه: إذا كنت تتحدث إحدى اللغات التالية، المساعدة متاح لك مجاناً. الرجاء طلب المساعدة من أحد موظفين.
Italian: Attenzione: Se parli una delle seguenti lingue, assistenza a vostra disposizione gratuitamente. Si prega di chiedere assistenza da un membro del personale.
German: Achtung: Wenn Sie eine der folgenden Sprachen sprechen, ist Hilfe Ihnen unentgeltlich zur Verfügung. Bitte fordern Sie Hilfe von einem Mitarbeiter.
Korean: 주의: 다음 언어 중 하나를 말하는 경우에 도움을 무료로 사용할 수입니다. 직원에서 도움 요청 하시기 바랍니다.
Polish: Uwagi: Jeśli mówisz, że jednym z poniższych języków, pomoc jest dostępna dla Ciebie bezpłatnie. Należy zwrócić się o pomoc od pracownika.
Gujarati: ધ્યાન: તમે નીચેની ભાષાઓમાં એક વાત તો મદદ તમારા માટે ઉપલબ્ધ વિના મૂલ્યે છે. એક સ્ટાફ સભ્ય પાસેથી સહાય મેળવવા માટે પૂછો.
Thai: ความสนใจ: ถ้าคุณพูดภาษาต่อไปนี้อย่างใดอย่างหนึ่ง มีบริการช่วยเหลือให้คุณฟรี กรุณาขอความช่วยเหลือจากพนักงาน
The following providers are contracted with Florida Specialty Surgery Center to provide services for patients:
Tampa Bay Anesthesia
6321 54th Avenue North
St.Petersburg, FL 33709
727-548-5100 Ext.203
Florida Medical Pain Management
6333 54th Avenue North
St. Petersburg, FL 33709
Phone: 727-548-6100