Montgomery Eye Center (ASC)

SEPARATE PROVIDERS

Services may be provided in this facility by the facility as well as by other health care providers who may separately bill the patient. Those separate health care providers may or may not participate with the same health insurers or health maintenance organizations (HMOs) as this facility. Patients and prospective patients should contact each health care provider who will provide services in the facility to determine the health insurers and HMOs with which the provider participates as a network provider or preferred provider.

Another health care provider who will bill you for services includes your physician performing the procedure. Other providers who will bill separately if they provide you with health care services in this surgery center include an anesthesia provider who delivers anesthesia services to you at the facility and a pathology provider and laboratory which will analyze tissue your physician may require be sent to the laboratory to diagnose your condition.

You can contact the facility’s anesthesia providers about whether they participate in your health plan.  The anesthesia providers are

Name of Anesthesia Provider Group: Coastal Anesthesia and Pain Management, LLC
Mailing address: P.O. box 10130, Naples, FL 34101
Telephone number: (239) 201-2881
Billing: billing@medi-corp.com

We may be required to send tissue for analysis by a pathology lab contracted with your health plan.  Your insurer’s provider network information may include the pathology lab in the insurer’s network of providers. You may want to check with your insurer.  Or, you can contact the laboratory directly about whether they participate in your health plan.

The pathology labs we send tissue to for analysis include

Name of pathology lab: Sarasota Pathology
Mailing address: 2001 Webber St, Sarasota, FL 34239
Telephone number: (941) 362-8900
Website: www.sarapath.com

Name of pathology lab:  Sarasota Memorial Hospital
Mailing address: 700 S Tamiami Trail, Sarasota, FL 34239
Telephone number: 941 917-9000
Website:  ww.smh.com

FINANCIAL ASSISTANCE ARRANGEMENTS

We only schedule procedures at this facility by physicians who are on the medical staff at the facility.  If your physician has determined that special financial assistance may be warranted and the physician agrees to those special financial arrangements for his or her services, you may be eligible for special financial assistance at the facility.  If your physician or the physician’s office staff have agreed to provide special financial assistance to you for a procedure the physician wants to schedule at this facility, please contact us. Please be advised that we do not provide charity care. However, we may provide a reduced fee depending upon your financial assistance needs and our verification of eligibility.

We will require you to complete an application for financial assistance that provides us with information about your income and expenses. This will allow us to access your need and qualifications for special financial assistance. Confirmation of eligibility includes verification of your household income through paycheck stubs, receipts for payment of mortgage or rent and utilities, last year’s tax filing, and information regarding changes since the last tax filing occurred. We follow the most recent poverty guidelines set by the U.S. Department of Health and Human Services.

Since these special financial arrangements do not apply to all patients, each patient should request individualized information particular to his or her financial situation.

HEALTH RELATED DATA & PRICING

Health related data, including quality measures and statistics for defined procedures can be found on the Agency for Healthcare Administration website https://quality.healthfinder.fl.gov/ the service bundle Information is a non-personalized estimate of costs that may be incurred by the patient for anticipated services and that actual cost will be based on services actually provided to the patient. The average pricing for bundled procedures can be found on the Agency for Healthcare Administration website at http://pricing.floridahealthfinder.gov.