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Patient
Information

Welcome to Orlando Avenue

Surgery Center

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Patient Information

Notice of Non-Discrimination

 Click here for Nondiscrimination

Patient Privacy Notice

 Click here for Patient Privacy Notice

Patient Rights & Responsibilities 

 Click here for Patient Rights & Responsibilities 

Ownership Notice

Dr. Randall Loy and Dr. Sharon Jaffe have ownership in the ambulatory surgery center. You have the right to

choose where to receive services. Please discuss with your physician if you are considering having surgery or a

procedure at another licensed facility. 

Advanced Directives

If you have an advance directive or living will, the Center will still transfer you to the closest hospital which will 

make decisions about following any advance directive or living will.  We will not honor Do Not Resuscitate 

requests.  You have a right to have your living will present in our medical record at the center and to be

informed of the center's policy prior to the procedure.  State information and forms to prepare an

advance directive, if you decide to have one, can be found at the following website:

https://quality.healthfinder.fl.gov/report-guides/advance-directives.

Patient Rights Under Florida Transparency Act of 2016:

Services Provided by Orlando Avenue Surgery Center, a State Licensed Health Care Facility

Orlando Avenue Surgery Center schedules patient care when your physician schedules a procedure for you

at this surgery center.  The facility has one fee that covers the following items: Nursing, technician and related services; use of the facility; testing for certain lab tests performed at the surgery center just as glucose (blood sugar), pregnancy, and hemoglobin; medications administered before, during and after your surgery while in the facility; surgical supplies used by the physician and staff; equipment used in the facility; surgical dressings; implants except those specifically classified as premium implants that require additional patient payment.

Separate Providers

Services may be provided in this facility by the facility as well as by other health care providers who may separately bill the patient. Those separate health care providers may or may not participate with the same health insurers or health maintenance organizations (HMOs) as this facility. Patients and prospective patients should contact each health care provider who will provide services in the facility to determine the health insurers and  HMOs with which the provider participates as a network provider or preferred provider.

Another health care provider who will bill you for services includes your physician performing the procedure. Other providers who will bill separately if they provide you with health care services in this surgery center include an anesthesia provider who delivers anesthesia services to you at the facility and a pathology provider and laboratory which will analyze tissue your physician may require be sent to the laboratory to diagnose your condition.

You can contact the facility’s anesthesia providers about whether they participate in your health plan.  The  anesthesia providers are:

U.S. Anesthesia Partners of Florida:

851 Trafalgar Court, Maitland, FL., 32751

(888) 339-8727

https://www.usap.com

We may be required to send tissue for analysis by a pathology lab contracted with your health plan.  Your insurer’s provider network information may include the pathology lab in the insurer’s network of providers. You may want to check with your insurer.  Or, you can contact the laboratory directly about whether they participate in your health plan.

The pathology labs we send tissue to for analysis include:

LabCorp

P.O. Box 2240, Burlington, NC 27216-2240

(800) 845-6167

www.labcorp.com

Estimate of Charges

Patient or prospective patients may request from this facility and other health care providers an estimate of charges prior to receiving services. Prospective patients or patients shall be provided an estimate or itemized statement or bill within 7 business days of request.   

Our estimate will be based upon the procedure your physician tells us that he or she plans to perform and the insurance information that you provide to us. We normally will contact your insurer to learn of your eligibility for the procedure and will then base our estimate upon what the insurer tells us about the payment they will make for the procedure. There is no guarantee that your insurance will process our claim for payment. The procedure your physician actually performs may differ from the initial one planned based upon your medical condition at the time of the procedure.  Since we cannot forecast the change, the estimate will be based upon the planned procedure as scheduled by your physician.

 

You may pay less or more for this procedure or service at another facility or in another health care setting.

 

Financial Assistance and Charity Care

Please be advised that we do not offer Financial Assistance or Charity care.

 

Collections

Prior to your scheduled procedure, we will contact you with the results of the verification of your insurance benefits to advise of your insurance deductible and co-payment amounts that will be due from you prior to your surgery. We expect the amount estimated due to be paid in advance of your procedure. If we receive denial of payment from your insurer or Health Maintenance Organization, we will notify you. If we receive payment from your insurer or HMO that is less than projected, we will notify you of any additional payment due. Payment will be expected within 30 days of notification of the balance due.  If you are unable to pay by that time, please contact our Billing department at (407) 917-2601 to discuss options.  At any point, prospective patients or patients have the right to request an estimate, update to a previous estimate and/or an itemized statement. Prospective patients or patients shall be provided an estimate or itemized statement or bill within 7 business days of request. If your account balance is not paid within 120 days, your account may then be turned over to an outside collection agency.

 

Health Related Data and Pricing

Health related data, including quality measures and statistics for defined procedures, can be found on the Agency for Healthcare Administration website at https://quality.healthfinder.fl.gov/. The service bundle information is a non-personalized estimate of costs that may be incurred by the patient for anticipated services and that actual cost will be based on services actually provided to the patient. The average pricing for bundled procedures can be found on the Agency for Healthcare Administration website at https://price.healthfinder.fl.gov/#!.

Surprise Medical Pricing Bills 

Accessibility Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

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, such as a copayment, coinsurance, and/or a deductible. You may have other 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” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay 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 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.

 

You are 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 the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). 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.

 

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 may 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 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 care out-of-network. You can choose a provider or facility in your plan’s network.

 

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

  • You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

  • Your health plan generally must:

    • Cover emergency services without requiring you to get approval for services in advance (prior authorization).

    • Cover emergency services by out-of-network providers.

    • 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 benefits.

    • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.​​

If you believe you’ve been wrongly billed, please visit www.cms.gov/nosurprises or call 1-800-985-3059.

Good Faith Estimate

Right to Receive a Good Faith Estimate of Expected Charges
Under the law, health care providers need to give patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

  • Make sure to save a copy or picture of your Good Faith Estimate.​

​For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.​

CONTACT US

For more information on your surgery, please contact 407-917-2601.

Location: 1500 S. Orlando Ave., Winter Park, FL 32789

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