Insurances

The Agency for Health Care Administration’s (AHCA’s) continues to place an emphasis on health care transparency for Florida’s consumers. AHCA offers a website – FloridaHealthPriceFinder to help patients find data on health care costs for national, state, and local prices.

Additionally, Andrews Institute ASC recognizes that the financial aspect of your care can be overwhelming. Our commitment to you is to be as transparent as possible and to provide you with the information to help you make decisions about your health care. Once you determine with your physician the services you require, Andrews Institute ASC can help you determine the price estimate of the service. We can provide estimates for those patients with or without insurance.

For the patients with insurance, you should first contact your insurance company to understand your plan benefits for the care/service you anticipate receiving from Andrews Institute ASC. You should confirm with your insurance company if the physician and the facility are both covered by your insurance plan. This is very important to know to help determine your total financial responsibility for the service you need.

If for any reason the physician or facility is not a participating provider with your insurance, your financial responsibility may increase.

What is pricing transparency?

“Pricing transparency” is the term used to describe initiatives in the health care industry to provide meaningful pricing information to consumers. The health care industry is often complex and difficult for consumers to navigate. Price transparency is a means of providing consumers price information on common services. Our facility is committed to presenting pricing information in a way that will be easy for the consumer to access and understand, as well as to providing other useful information about financial assistance available, definitions of key terminology and key financial policies. Using the AHCA website, FloridaHealthPriceFinder, a consumer can determine national, state, and local pricing for a variety of health care services. Patients and prospective patients should recognize that the 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.

Your claim may be affected by many variables. In order for your claim to be filed in a correct and timely manner, we require up-to-date patient and insurance information prior to each visit. This includes current, active insurance card(s), valid photo ID and any other requested documentation. Should your insurance company contact you for further information before or after your claim has been filed, please respond promptly.  Any delay in your response may cause a delay and/or denial of your claim.

Although infrequent, if your insurance carrier reimburses you directly it is expected that you will contact our offices immediately to determine proper processing. In the event the insurance company has not paid your claim within 90 days, you may be held responsible for the timely payment of your account. While we do everything possible to assist in the accurate processing of your claim, Andrews Institute Ambulatory Surgery Center will not become directly involved in disputes between you and your insurance provider.

We accept most insurance plans.  Please refer to the list below; if you do not see your plan, or have any questions, please contact your insurance company and/or our Patient Access Department at (850) 916-8531 for assistance.  Information for self-pay/uninsured patients can be found at the bottom of this page.

Accepted In-Network Carriers

Andrews Institute Ambulatory Surgery Center is proud to contract with the above carriers. However, to ensure that your specific plan (as contracted between you and the specified insurance carrier) is accepted, it is imperative that we receive the most up-to-date insurance information. If you have any questions please contact your insurance provider and/or an Andrews Institute Patient Access team member at (850) 916-8531.

All co-payments must be paid at or prior to the time of service. The co-pay is (usually) a capped contribution, determined by your insurance contract, payable by the patient each time a medical service is rendered.

If applicable, your estimated deductible and co-insurance information will be provided to you prior to your procedure. A deductible is the amount you must pay out-of-pocket for services prior to your insurance company providing reimbursement. Similarly, co-insurance is an amount agreed upon in your insurance contract which outlines shared responsibility for reimbursement totals, usually comprised of a percentage of the total amount. Sometimes this is affected by your deductible; therefore, it is recommended that you reference your individual insurance policy for the most accurate and up-to-date information.

At times, based on the contractual obligations assigned to you by your insurance carrier and due to various circumstances of the surgical procedure(s), your insurance provider will assign a specific amount as ‘Patient Responsibility’ after your claim has been filed and processed.  This can include, but is not limited to, your co-insurance and deductibles and is often calculated based on other medical expenses which have been incurred and filed for pre/post-surgery. This amount is found on each patient’s Explanation of Benefits (EOB). Any assigned balances remaining after your insurance provider has made applicable reimbursement payments are defined as Patient Responsibility.

In order to ensure the best possible patient experience, Andrews Institute Ambulatory Surgery Center will work on your behalf to obtain the most accurate information from your insurance provider(s) and calculate various factors to provide you with the most accurate pre-surgery estimate.  It is our intent that this value is as accurate as possible; however, based on circumstance outside of our control this may change. That being said, any amounts provided prior to surgery can only be taken as good faith estimates. Any and all final balances will be billed to you according to our standard billing guidelines.  Should you have any questions related to your estimate, please contact our Patient Access Team at (850) 202-1262.

Many insurance providers require a pre-authorization for surgical procedures. It is the responsibility of your physician’s office to obtain any pre-authorization necessary for your procedure. In conjunction with verifying benefits with your insurance provider(s), we will attempt to coordinate with the physician’s office to ensure (if necessary) that your pre-authorization has been obtained.

At times, the insurance carrier will need additional information from the patient as it pertains to verifying these pre-authorizations. We ask that you be diligent in your response to said carriers as it may affect the scheduling of your surgical procedure.

Some procedures performed in the Surgery Center may be deemed investigational or are otherwise unpaid by insurance carriers. In the event your insurance provider allows for, we will require an Advance Beneficiary Notice (ABN) to be signed by the patient/guarantor.

ABN Guidelines

Option 1 – The patient elects for the surgical procedure/implant and wants their insurance provider billed. Andrews Institute Ambulatory Surgery Center may ask to be paid at the time of service, but the insurance provider will also be billed for an official decision. If the insurance provider does not pay, the patient is responsible, but can appeal the decision directly to the carrier (using instructions provided on the determination form). In the event the provider does pay, a refund (if applicable) will be issued to the patient for payments made on the procedure in question after any applicable patient responsibility has been applied.

Option 2 – The patient elects to have the surgical procedure/implant but does not want their insurance provider billed. Andrews Institute Ambulatory Surgery Center may ask for payment at the time of service, but the patient cannot appeal to their insurance provider and is solely responsible for payment of the procedure/implant.

Option 3 – The patient does not want the procedure/implant. The procedure/implant will not be performed or used. Alternate accommodations will be made regarding the patient’s surgery and billing. 

If your scheduled procedure is the result of a work-related injury, the Andrews Institute Ambulatory Surgery Center will require your worker’s compensation insurance information as well as your personal health insurance information. It is standard practice in these claims for your employer to provide you with their Worker’s Compensation Insurance Carrier information. This includes the provider name and contact number, a contact person and a claim number. Any worker’s compensation claims denied by your employer’s worker’s compensation provider will become your sole responsibility.

For patients who are uninsured/self-pay, an estimate will be provided to you by our Patient Access Team. It is required that 100% of the surgical fees be paid at least one week prior to your scheduled surgery or the surgery will be cancelled

For patients who are having elective cosmetic surgery, an estimate will be provided to you by our Patient Access Team. It is required that 100% of the surgical fees be paid at least one week prior to your scheduled surgery or the surgery will be cancelled.

For your convenience we accept all major credit/debit cards (Visa, MasterCard, American Express, and Discover) and payment plan options through Care Credit. Below is a direct link to get started with Care Credit for any needed payment plan assistance.

https://www.carecredit.com/go/344MQG/

Full payment of your estimated co-pay, deductible, and/or co-insurance is expected prior to date of service. Please contact our Patient Access Team at (850) 202-1262 for additional information.

At any time, for payment or any other related concerns, it is at the discretion of the Andrews Institute Ambulatory Surgery Center Administrator, Surgeon, and/or Leadership to cancel or postpone your scheduled surgery.  Please contact our staff if you have any questions.