In an effort to promote health care price and quality transparency to enable consumers to make
informed choices regarding health care treatment, our team can accommodate requests made for any
of the following by calling the facility:

• Personalized Financial Estimate: Upon a patient’s request, the ASC and health care providers can
  provide a more personalized estimate of charges and other information prior to the service; including
  patients with no insurance. Please note that the payments and payment ranges are an estimate cost
  that may be incurred and your actual cost may vary based on actual services rendered. Services may
  be provided by the ASC as well as by other health care providers who may separately bill; such health
  care providers may or may not participate with the same health insurers or HMOs as the ASC. It is
  recommended that you reach out to your health care provider to understand what networks in which
  they participate. Patients should contact each health care practitioner who will provide services in the
  ASC to determine the health insurers and HMOs with which the health care practitioner participates as
  a network provider or preferred provider. Please see the providers tab on our website for more
  information on the providers that provide services at the ASC.
• Budget Agreement: to assist a patient in setting up a payment plan for out-of-pocket costs like
  co-insurance, deductibles, etc.
• Financial Hardship/Charity Application: patients can apply for financial hardship when they meet the following criteria:
  1. Income level is based on income levels of the full household in which the patient resides.
  2. Household income must fall within the Financial Hardship tiered pricing grid.
  3. Patient must complete and sign the Financial Verification Form.
  4. Patient must provide proof of all household income.

Pricing information is made available at www.floridahealthfinder.gov.
For more information, please contact Suncoast Surgery Center at (727) 853-1851.