Financial Assistance Policy
If Fort Myers Surgery Center believes that you have health insurance and/or HMO coverage(s) that may cover some or all of the Services, Fort Myers Surgery Center may initiate contact with them to determine your cost-sharing responsibilities for Fort Myers Surgery Center’s bill. You may contact them directly as well for additional information concerning your cost-sharing responsibilities. If Fort Myers Surgery Center determines that you have cost-sharing responsibilities for Fort Myers Surgery Center’s bill, in accordance with Fort Myers Surgery Center’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. Fort Myers Surgery Center’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 Fort Myers Surgery Center, 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 Fort Myers Surgery Center to be “charity care.” There is no formal application process for obtaining “charity care” at Fort Myers Surgery Center. Fort Myers Surgery Center’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 Fort Myers Surgery Center, you can receive a good faith estimate of anticipated charges for the treatment of your condition at Fort Myers Surgery Center. This estimate must be provided to you within seven (7) days of the request being received by Fort Myers 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 Fort Myers Surgery Center at 239-772-3636.
Itemized Bill
Upon request and after discharge from Fort Myers Surgery Center we will provide a statement within 7 working days of your request.
Provider Disclosure
Services may be provided in this health care facility by Fort Myers 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 Fort Myers Surgery Center. You may request a more personalized estimate of charges from these other health care providers by contacting the health care providers directly. Fort Myers Surgery Center may contract with providers for pathology and anesthesiology services; these services are billed separately from Fort Myers Surgery Center for their services. You may contact these providers through their contact information provided below.
Fort Myers Surgery Center Providers
Dr. Brian Rajca
625 Del Prado Blvd S.
Cape Coral Fl. 33990
CRH Anesthesia of Florida
1-800-660-2153
227 Bellevue Way NE, #188
Bellevue WA 98004
Ameripath Southwest Florida
239-275-1164
1620 Medical Lane, #100
Fort Myers, Fl. 33907
Patient Health Record
Upon request and after discharge from Fort Myers Surgery Center, Fort Myers Surgery Center 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.
Patient Complaint or Grievance
To report a complaint or grievance, you can contact the facility Administrator by phone at 239-887-3608 or by mail at:
Fort Myers Surgery Center
13051 University Drive Ft. Myers, Florida 33907