Billing and Regulatory Information

At Florida Heart & Vascular Surgery Center, we are dedicated to providing high-quality healthcare in a transparent and accessible manner. Understanding your billing and financial responsibilities is essential to your experience with us. We are committed to ensuring that our billing practices comply with all applicable federal and state regulations, including those set by CMS and AHCA.

Billing Process

We strive to make the billing process as seamless and straightforward as possible. Here’s how our billing process works:

• Insurance Verification: Prior to your procedure, we will verify your insurance coverage. This includes confirming your benefits, determining your deductible, co-pays, and co-insurance, and verifying whether any prior authorization is needed for the procedure.

• Procedure Estimate: Once your insurance is verified, you will receive an estimate of the charges for your procedure. This estimate will include facility fees, physician/surgeon fees, and any other related costs. While this is only an estimate, we make every effort to provide as accurate an estimate as possible.

• Billing Submission: After your procedure, we will submit a claim to your insurance company on your behalf. Your insurance company will then process the claim and determine what portion of the charges is covered under your plan.

• Patient Responsibility: Once your insurance has processed the claim, you will receive a bill for any remaining balance, including co-pays, co-insurance, and any amounts that apply to your deductible. Payment is due upon receipt of your billing statement.

• Payment Options: We offer several convenient payment methods, including credit cards, checks, and online payments. Additionally, if you are unable to pay your bill in full, we offer payment plans and financial assistance programs for eligible patients.

Insurance Plans Accepted

We accept a wide variety of insurance plans, including but not limited to:

• Medicare

• Medicaid

• Commercial insurance plans (Blue Cross Blue Shield, Aetna, UnitedHealthcare, etc.)

• Self-pay options for uninsured patients

If your insurance plan is not listed or you have any questions about your coverage, please contact our billing office for assistance.

Medicare and Medicaid Billing

We follow all Medicare and Medicaid guidelines for billing and reimbursement. For Medicare patients, the standard Part B deductible and co-insurance amounts apply. Medicaid beneficiaries may have additional requirements, and our staff will assist you with any pre-authorization or documentation needs.

Regulatory Compliance

Our billing practices are fully compliant with CMS and AHCA regulations to ensure transparency, fairness, and patient protection.

• No Surprises Act: In compliance with the No Surprises Act, patients will not receive unexpected bills for emergency services or out-of-network care that was not chosen. We will ensure that all patients are informed of their in-network and out-of-network financial responsibilities prior to receiving care.

• Price Transparency: In accordance with CMS and AHCA requirements, we provide upfront pricing estimates for common procedures. These estimates are available upon request or through our online Price Transparency Tool.

• AHCA Compliance: We comply with all AHCA rules and regulations, including the submission of financial data to the Florida Health Care Transparency Database, where patients can access information about healthcare costs at our center.

• No Surprise Billing and Balance Billing Protections

• In compliance with the No Surprises Act, we take the following steps to protect our patients from unexpected medical bills:

• Emergency Services: If you receive emergency care at our center, you will not be billed more than the allowed in-network cost-sharing amount for any out-of-network services.

• Non-Emergency Services: For non-emergency services, if we are unable to contract with your insurance company, we will inform you in advance if any part of your care will be out-of-network. You have the right to request a Good Faith Estimate before receiving out-of-network care.

• Balance Billing: You will not be balance billed for covered services that fall under No Surprise Billing protections. However, for services outside these protections, you may be responsible for out-of-pocket costs.

Understanding Your Bill

Your bill will include the following details:

• Facility Charges: These charges cover the cost of the surgery center, including the use of equipment, nursing staff, and other resources necessary for your procedure.

• Physician/Surgeon Charges: These charges are for the surgeon or physician performing your procedure. Some surgeons may bill separately, so you may receive more than one bill depending on your provider's billing practices.

• Anesthesia Fees: If your procedure requires anesthesia, you may receive a separate bill for these services. This fee covers the cost of the anesthesia provider and related services.

• Other Services: Depending on your procedure, you may receive additional bills for services such as laboratory tests, diagnostic imaging, or pathology. These services may be billed separately by third-party providers.

Disputing a Bill

If you believe there is an error on your bill or you have questions about a charge, please contact our billing office at 863-937-7232 or contact@flheartvascular.com. Our billing specialists are available to review your bill and help resolve any discrepancies.

If you are unable to resolve your concerns with our billing office, you have the right to file a complaint with the AHCA or CMS. For more information, visit the CMS website by clicking  

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Financial Assistance and Charity Care

We are committed to providing affordable care to all patients. If you are experiencing financial hardship, you may qualify for our Charity Care Program or a Payment Plan. Our financial counselors are available to help you understand your options and guide you through the application process.

Contact Us

If you have any questions about your bill, insurance coverage, or financial options, please contact our billing office at 863-937-7232 or email us at contact@flheartvascular.com. We are here to help you navigate the billing process and ensure you understand your financial obligations.

Frequently Asked Questions

1. How will I know if my insurance covers the procedure?
Our billing team will verify your insurance coverage before your procedure and provide you with a financial estimate based on your plan's coverage.

2. Can I set up a payment plan if I can’t pay my bill in full?
Yes, we offer flexible payment plans for patients who need more time to pay their bill. Please contact our billing office to discuss your options.

3. What should I do if I receive a bill I don’t understand?
If you receive a bill you do not understand, contact our billing office immediately. We will review your account and clarify any charges or discrepancies.

4. Are there any protections against surprise bills?
Yes, we comply with the No Surprises Act, which protects you from unexpected bills for out-of-network services, especially in emergency situations.

CMS and AHCA Compliance

This Billing and Regulatory Information section complies with CMS and AHCA regulations, ensuring transparent, fair billing practices. By adhering to CMS standards for Medicare and Medicaid, as well as AHCA rules for price transparency and financial reporting, we ensure that all patients are fully informed of their financial responsibilities and have access to the resources they need to manage their healthcare costs.