Financial Assistance Policy
Premier Surgical Suites, LLC believes that you have health insurance and/or HMO coverage(s) that may cover some or all of the Services, Premier Surgical Suites, LLC may initiate contact with them to determine your cost-sharing responsibilities for Premier Surgical Suites, LLC bill. You may also contact them directly as well for additional information concerning your cost-sharing responsibilities. If Premier Surgical Suites, LLC determines that you have cost-sharing responsibilities for Premier Surgical Suites, LLC bill, in accordance with Premier Surgical Suites, LLC financial assistance policies, you will be required to pay your cost-sharing responsibilities in full on or before the date that Services are provided. Premier Surgical Suites, LLC 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 Premier Surgical Suites, LLC, 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 Premier Surgical Suites, LLC to be “charity care.” There is no formal application process for obtaining “charity care” at Premier Surgical Suites, LLC, 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 Premier Surgical Suites, LLC, you can receive a good faith estimate of anticipated charges for the treatment of your condition at Premier Surgical Suites, LLC. This estimate must be provided to you within seven (7) days of the request being received by Premier Surgical Suites, LLC. 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 Premier Surgical Suites, LLC at 727-604-5090.
Out-of-Network Billing and Non-Covered Fees
https://forms.office.com/r/iAN1CW67HT
Itemized Bill
Upon request and after discharge from Premier Surgical Suites, LLC we will provide a statement within 7 working days of your request.
Provider Disclosure
Services may be provided in this health care facility by Premier Surgical Suites, LLC 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
Premier Surgical Suites, LLC. You may request a more personalized estimate of charges from these other health care providers by contacting the health care providers directly.
Premier Surgical Suites, LLC may contract with providers for pathology and anesthesiology services; these services are billed separately from Premier Surgical Suites, LLC for their services. You may contact these providers through their contact information provided below.
Premier Surgical Suites, LLC Providers
Jason Alexander Alonso, M.D.
Anesthesia Resources, L.L.C.
Tampa, FL, 33615
Roderick M Urbaniak, MD
Urbaniak Plastic Surgery M.D. PA
13201 WALSINGHAM ROAD STE 200
LARGO, FL 33774
Baycare Laboratory
Morton Plant
300 Pinellas Street
Clearwater, FL 33756
727-462-7062
Patient Health Record
Upon request and after discharge from Premier Surgical Suites, LLC, PSS 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.