Privacy Policy

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Summary of Privacy Practices

• Treatment Such as when our physicians and nurses discuss your care.
• Payment Such as when we bill your insurance company for services provided to you.
• Operations Such as when we work to make the quality of the care that that we provide better.  When we give out information about the different services we provide.
• Other ways such as when we respond court requests, funeral directors, and state reports.

• http://www.floridahealthfinder.gov/index.html 

• As a courtesy to our patients, we will file an insurance claim on behalf of the patient to his/her insurance plan. If an insurance plan requests additional information from the patient, we require prompt response in order to minimize payment delays.
• Patients are expected to pay their financial obligations in a timely manner. Denied/ $0 pay claims by the payer may result in the entire contractual amount transferred to the patient for collection.
• For all outstanding patient balances, the facility will attempt to reach patients by any method available to us to secure payment including monthly statements and patient phone calls. If the account becomes delinquent, the balance may be placed with an outside collection agency.
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• Estimate of charges
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• Grace Surgery Center will verify your health insurance benefits prior to surgery and bill your carrier
• following your procedure. Estimated patient responsibility of co-pay portions, deductibles, and/or out of
• pocket fees are expected on the day of surgery. We accept cash and credit cards. We also are able to
• offer financing of your portion of the bill through Care Credit, an organization established for this
• purpose.

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• GRACE SURGERY CENTER
• 
  
• You have the right to receive a “GOOD FAITH ESTIMATE” explaining how much
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• your health care will cost.
• 
  
• Under the law, health care providers need to give patients who do not have
• insurance or who are not using insurance an estimate of their bill for health care
• items and services before those items or services are provided.
• 
  
•  You have the right to receive a GOOD FAITH ESTIMATE for the total
• expected cost of any health care items or services upon request or when
• scheduling such items or services. This includes related costs like medical
• tests, prescription drugs, and hospital fees.
•  If you schedule a health care service at least three business days in
• advance, make sure your health care provider or facility gives you a GOOD
• FAITH ESTIMATE in writing within one business day. If you schedule
• services at least 10 days, the health care provider or facility gives you a
• GOOD FAITH ESTIMATE in writing within three business days. You can
• also ask any health care provider or facility for a GOOD FAITH ESTIMATE
• before you schedule an item of service.
•  If you receive a bill that is at least $400.00 more for any provider or facility
• than your GOOD FAITH ESTIMATE from that provider or facility, you can
• dispute the bill.
• 
  
• For questions or more information about your right to a GOOD FAITH ESTIMATE, visit
• www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@sms@sms.hhs.gov, or call 1-800-
• 985-3059
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GRACE SURGERY CENTER

STATE OF FLORIDA TRANSPARENCY IN HEALTH CARE LEGISLATION

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. The

following providers are contracted with Grace Surgery Center to provide services for patients:

Paul Jo, MD

352-351-0029

Brent Compton MD

352-350-6500

Alethia Pantazis MD

352-804-2397

Brent Carter DPM

352-388-4680

Stephanie Frey DPM

239-276-6173

Marcus Frey DPM

352-574-6995

Apex Anesthesia

Emeritus Laboratories

949-418-7225

Quest Laboratories

1-866-697-8378

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Summary of State Balance Billing Protections

1. Arizona

Arizona also provides various balance billing protections. In most instances, your health plan must hold

you harmless for charges above your in-network cost share amount for emergency services provided by

out-of-network providers at in-network facilities. Claims over $1,000 may also be eligible for dispute

resolution. For more information about your specific rights under Arizona law, visit www.difi.az.gov.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.difi.az.gov for more information about your rights under Arizona law.

2. California

California also provides various balance billing protections. In most instances, you cannot be charged

more than your in-network cost share amount for emergency and non-emergency services. California

also has a voluntary, non-binding dispute-resolution process for emergency services. For more

information about your specific rights under California law, visit www.insurance.ca.gov.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.insurance.ca.gov for more information about your rights under California law.

3. Colorado

Colorado also provides various balance billing protections. In most instances, you cannot be charged

more than your in-network cost share amount for emergency and non-emergency services. For more

information about your specific rights under Colorado law, visit www.doi.colorado.gov.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.doi.colorado.gov for more information about your rights under Colorado law.

4. Connecticut

Connecticut also provides various balance billing protections. In most instances, you cannot be charged

more than your in-network cost share amount for emergency services, and non-emergency services

provided at in-network facilities. For more information about your specific rights under Connecticut

law, visit www.portal.ct.gov/CID.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.portal.ct.gov for more information about your rights under Connecticut law.

5. Delaware

Delaware also provides various balance billing protections. In most instances, your health plan must

hold you harmless for emergency services provided by out-of-network providers at out-of-network

facilities. Providers also cannot balance bill you for non-emergency services provided at in-network

facilities without obtaining your consent. For more information about your specific rights under

Delaware law, visit www.insurance.delaware.gov.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.insurance.delaware.gov for more information about your rights under Delaware law.

6. Florida

Florida also provides various balance billing protections. In most instances, you cannot be charged more

than your in-network cost share amount for emergency and non-emergency services. For more

information about your specific rights under Florida law, visit www.floir.com/index.aspx.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.floir.com/index.aspx for more information about your rights under Florida law.

7. Illinois

Illinois also provides various balance billing protections. In most instances, you cannot be charged more

than your in-network cost share amount for emergency and non-emergency services provided by out-of-

network providers at in-network facilities. For more information about your specific rights under Illinois

law, visit www2.illinois.gov/sites/Insurance.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www2.illinois.gov/sites/Insurance for more information about your rights under Illinois law.

8. Indiana

Indiana also provides various balance billing protections. In most instances, you cannot be charged more

than your in-network cost share amount for emergency services, and for non-emergency services

provided at in-network facilities. For more information about your rights under Indiana law, visit

www.in.gov/idoi/.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.in.gov/idoi/ for more information about your rights under Indiana law.

9. Massachusetts

Massachusetts also provides various balance billing protections. In most instances, you cannot be

charged more than your in-network cost share amount for emergency and non-emergency services

provided by out-of-network providers at in-network facilities. For more information about your rights

under Massachusetts law, visit www.mass.gov/orgs/division-of-insurance.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.mass.gov/orgs/division-of-insurance for more information about your rights under

Massachusetts law.

10. Maryland

Maryland also provides various balance billing protections. In most instances, you cannot be charged

more than your in-network cost share amount for emergency services, and for non-emergency services

provided by out-of-network providers at in-network facilities. For more information about your rights

under Maryland law, visit www.insurance.maryland.gov.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.insurance.maryland.gov/Pages for more information about your rights under

Maryland law.

11. Michigan

Michigan also provides various balance billing protections. In most instances, you cannot be charged

more than your in-network cost share amount for emergency services, and for non-emergency services

provided by out-of-network providers at in-network facilities. For more information about your rights

under Michigan law, visit www.michigan.gov/difs.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.michigan.gov/difs for more information about your rights under Michigan law.

12. Minnesota

Minnesota also provides various balance billing protections. In most instances, your plan must hold you

harmless for amounts beyond your in-network cost share amount for non-emergency services provided

by out-of-network providers at in-network facilities. For more information about your rights under

Minnesota law, visit www.mn.gov/commerce/consumers/your-insurance.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.mn.gov/commerce/consumers/your-insurance for more information about your

rights under Minnesota law.

13. Missouri

Missouri also provides various balance billing protections. In most instances, you cannot be charged

more than your in-network cost share amount for emergency services provided by out-of-network

providers at in-network facilities. For more information about your rights under Missouri law, visit

www.insurance.mo.gov.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.insurance.mo.gov for more information about your rights under Missouri law.

14. Mississippi

Mississippi also provides various balance billing protections. In most instances, you cannot be charged

more than your in-network cost share amount for emergency services, and for non-emergency services

provided by out-of-network providers at in-network facilities. For more information about your rights

under Mississippi law, visit www.mid.ms.gov/about/commissioner.aspx.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.mid.ms.gov/about/commissioner.aspx for more information about your rights under

Mississippi law.

15. North Carolina

North Carolina also provides various balance billing protections. In most instances, your health plan

must hold you harmless for amounts beyond your in-network cost share amount for emergency services

provided by out-of-network providers. For more information about your rights under North Carolina

law, visit www.ncdoi.gov.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.ncdoi.gov for more information about your rights under North Carolina law.

16. New Jersey

New Jersey also provides various balance billing protections. In most instances, you cannot be charged

more than your in-network cost share amount for emergency services, and for non-emergency services

provided by out-of-network providers at in-network facilities. For more information about your rights

under New Jersey law, visit www.state.nj.us/dobi/index.html.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.state.nj.us/dobi/index.html for more information about your rights under New Jersey

law.

17. New Mexico

New Mexico also provides various balance billing protections. In most instances, you cannot be charged

more than your in-network cost share amount for emergency services, and for non-emergency services

provided by out-of-network providers at in-network facilities. For more information about your rights

under New Mexico law, visit www.newmexico.gov/category/other-affected-services/office-of-the-

superintendent-of-insurance.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.newmexico.gov/category/other-affected-services/office-of-the-superintendent-of-

insurance for more information about your rights under New Mexico law.

18. Nevada

Nevada also provides various balance billing protections. In most instances, your health plan must hold

you harmless for amounts beyond your in-network cost share amount for emergency services provided

by out-of-network providers and facilities. For more information about your rights under Nevada law,

visit www.doi.nv.gov.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.doi.nv.gov for more information about your rights under Nevada law.

19. Ohio

Ohio also provides various balance billing protections. In most instances, your health plan must hold you

harmless for amounts beyond your in-network cost share amount for emergency services by out-of-

network providers, facilities, and ground ambulance service providers, and for non-emergency services

by out-of-network providers at in-network facilities. For more information about your rights under Ohio

law, visit www.insurance.ohio.gov.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.insurance.ohio.gov for more information about your rights under Ohio law

20. Oregon

Oregon also provides various balance billing protections. In most instances, you cannot be charged more

than your in-network cost share amount for emergency services, and for non-emergency services

provided by out-of-network providers at in-network facilities. For more information about your rights

under Oregon law, visit www.dfr.oregon.gov/Pages/index.aspx.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.dfr.oregon.gov/Pages/index.aspx for more information about your rights under

Oregon law.

21. Pennsylvania

Pennsylvania also provides various balance billing protections. In most instances, your plan must hold

you harmless for amounts beyond your in-network cost share amount for emergency services. For more

information about your rights under Pennsylvania law, visit www.insurance.pa.gov.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.insurance.pa.gov for more information about your rights under Pennsylvania law.

22. Texas

Texas also provides various balance billing protections. In most instances, you cannot be charged more

than your in-network cost share amount for emergency services, and for non-emergency services

provided by out-of-network providers at in-network facilities. For more information about your rights

under Texas law, visit www.tdi.texas.gov.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.tdi.texas.gov for more information about your rights under Texas law.

23. Washington

Washington also provides various balance billing protections. In most instances, you cannot be charged

more than your in-network cost share amount for emergency services, and for non-emergency services

provided by out-of-network providers at in-network facilities. For more information about your rights

under Washington law, visit www.insurance.wa.gov.

- Visit www.cms.gov/nosurprises/consumers for more information about your rights under

federal law.

- Visit www.insurance.wa.gov for more information about your rights under Washington law