East Coast Surgery Center

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 East Coast Surgery Center to provide services for patients:

Jacksonville Anesthesia Corporation, Inc. P.O. Box 416 Ponte Vedra, FL 32204 Phone: 904-238-4147

Radiology Imaging Associates 1673 Mason Avenue, Suite 305 Daytona Beach, FL 32117 Phone: 386-274-7118

Additional information regarding health care quality measures and statistics provided by the State of Florida Agency for Health Care Administration can be found at https://pricing.floridahealthfinder.gov/.

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays, and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

You’re protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Additionally, Florida law protects patients with coverage through a Health Maintenance Organization (“HMO”) from balance billing for covered services, including emergency services, when the services are provided by an out-of-network provider.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you unless you give written consent and give up your protections.

You’re NEVER required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

Additionally, Florida law also protects patients with coverage through Preferred Provider Organization (“PPO”) or an Exclusive Provider Organization (“EPO”) from balance billing for covered services provided at hospitals, urgent care centers or ambulatory care centers for (1) emergency services and (2) non-emergency services provided at an in-network facility by an out-of-network provider if the patient did not have the opportunity to choose an in-network provider. This protection only requires patients to pay their in-network cost sharing amounts.

When balance billing isn’t allowed, you also have these protections:

You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.

Generally, your health plan must:

• Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
• Cover emergency services by out-of-network
• Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of
• Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket

If you think you’ve been wrongly billed:

Contact The U.S. Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) or visit https://www.cms.gov/nosurprises/ consumers for more information about your rights under federal law.

The Florida Department of Financial Services, Division of Consumer Services at 1-877-693 – 5236 (1-877-MY-FL-CFO).

The federal phone number for information and complaints is: 1-800-985-3059.