ECP Financial Policy
850-474-8988

ECP Financial Policy

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FINANCIAL POLICY

Our Financial Policy: At the Endoscopy Center our policy is to provide exceptional health care services. We are providing this Financial Policy so you will understand our billing process and your obligations for payment of your account. We have agreements with insurance companies and other payors and bill in accordance with the terms of the contracts. Our fees will be adjusted to the contracted amount with the insurance company. You will find data on health care cost for national, state and country prices at pricing.floridahealthfinder.gov.

Our Policy: Our policy requires payment of co-payments, co-insurance, and any deductibles at the time of service. If there is any patient balance owed after all insurance companies have made their payments, the patient will be sent a statement for that amount.

Patient Responsibilities: As a courtesy, we will bill your insurance for all services; however, we ask that you pay any portion of your costs not covered by your insurance due to deductibles, co-insurances or co-payments, non-covered procedures and services that are performed less the insurance contractual adjustments.

It is the responsibility of the patient to supply us with your correct address, employment and insurance information, a copy of your insurance card and any necessary referral information or authorization from your primary care physician.

You are required to provide us with 72 hours advanced notification if you will not be able to attend your scheduled procedure. Failure to provide this notification will result in a $125.00 no show charge or $250.00 if you were scheduled for two procedures on the same day. This charge must be paid prior to your next scheduled procedure.

PAYMENT POLICY

For your convenience we offer several payment methods including: Check, Cash, MasterCard®, Visa®, and Discover®. Payments may be made on our website at www.endo-world.com, called in at 850-477-8109 or mailed to 4828 North Davis Hwy., Pensacola, Fl. 32503.

A $25.00 fee will be charged for returned checks. Full payment is expected within 90 days of service.

All credit card payments are processed through the Endoscopy Centers credit card machine at the time of service.

Receipts are given for all payments received from patients, whether cash, check or charge.

Cash, checks and credit cards will be sent to the billing office.

Appointment reminder calls begin four days prior to visit and the day before the appointment. Patients with existing balances will be asked to bring that along with their co-pay and/or deductible with them.

Copayments will be collected at the time the patient checks in for his/her appointment. If a patient does not have their copayment the billing office will be notified and a decision will be made regarding payment options or rescheduling options.

The receptionist will balance all monies received for the day and send to billing office.

COLLECTION PROCEDURE
If you have no insurance or elect to self-pay your account, payment is due at the time of service unless you have made previous arrangements with our billing staff.

Any account balance that is not paid within 90 days from the date you were billed by the Center may be forwarded to an outside agency for collection follow-up.

Prior to considering an account uncollectable, every effort will be made to collect the money owed. This process starts at the time of patient appointments. If an account is self-pay from the beginning with no insurance coverage, a payment should be collected at each visit and a mutually acceptable payment arrangement established with the patient for unpaid balances.

CHARITY CARE AND FINANCIAL ASSISTANCE
The Endoscopy Center is committed to providing Charity Care and Financial Assistance to persons who are uninsured, underinsured, or otherwise unable to pay for medically necessary care based on their individual financial situation. If a patient is unable to pay and feels that they have a financial hardship and upon request, Endoscopy Center may offer a discount on the amount due and/or offer a payment plan. There is no formal application process. Financial hardship must be documented in the patient financial records.
The Endoscopy Center is committed to treating patients who have financial needs with the same dignity and consideration that is extended to all patients.

ESTIMATES

Every estimate shall include:
• A statement informing the requestor to contact their health insurer or HMO for anticipated cost sharing responsibilities,
• A statement advising the requestor that the actual cost may exceed the estimate.
• The web address to financial assistance policies, charity care policy, and collection procedure.
• A description and purpose of any facility fees, if applicable.
• A statement that services may be provided by other health care providers who may bill separately.
• A statement, including a web address if different from above, that contact information for health care practitioners and medical practice groups that are expected to bill separately is available on the center’s website.
• The estimate shall include a statement that a personalized estimate is available upon request.
• A personalized estimate must include the charges specific to the patient’s anticipated services.

INSURANCE INFORMATION

• Service bundle information is a non-personalized estimate of costs that may be incurred by the patient for anticipated services and that actual costs will be based on services actually provided to the patient
• Patients or representatives have a right to request a personalized estimate from the Center
• Entities from which you may receive a bill:
Gastroenterology Associates of Pensacola (physician services)
4828 North Davis Hwy., Pensacola, Florida 32503 850-474-8988

Endoscopy Center of Pensacola (facility charges)
4810 North Davis Hwy., Pensacola, Florida 32503 850-474-8988

Gastroenterology Associates of Pensacola, Pathology Division (biopsies/specimen)
517 East Selina St., Pensacola, Florida 32503 850-474-8988

Gastroenterology Associates of Pensacola, Anesthesiology Division (anesthesia)
4828 North Davis Hwy., Pensacola, Florida 32503 850-474-8988

If your insurance provider has preferences for your pathology specimen you will receive a bill from that company.

• You may contact the health care practitioners anticipated to provide services to the patient while in the center regarding a personalized estimate, billing practices and participation with the patient’s insurance provider or health maintenance organization (HMO) as the practitioners may not participate with the same health insurers or HMO as the center.
• The center shall provide an estimate upon request of the patient, prospective patient, or legal guardian for nonemergency medical services.
• An estimate or an update to a previous estimate shall be provided within 7 business days from receipt of the request. Unless the patient requests a more personalized estimate, the estimate may be based upon the average payment received for the anticipated service bundle.
• Patients should contact their health insurer or HMO for anticipated cost sharing responsibilities.
• Our fee schedule is reflective of the usual and customary for Gastroenterology services in the Southeast. The patient may pay less for the procedure or service at another facility or in another health care setting.
• Itemized statement or bill. The center shall provide an itemized statement or bill upon request of the patient or the patient’s survivor or legal guardian. The itemized statement or bill shall be provided within 7 business days after the patient’s discharge or release, or 7 business days after the request, whichever is later. The itemized statement or bill must include a description of the individual charges from each department or service area by date, as prescribed in subsection 395.301(1)(d), F.S.;
• If any questions or concerns arise regarding our Financial Policy, please do not hesitate to contact the bill staff at 850-477-8109.

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