Welcome to The Orthopedic Clinic Surgery Center

Services may be provided in this health care facility by the facility as well as 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 the facility.

Patients and prospective patients may request from this facility and other health care providers a more personalized estimate of charges and other information. Patients and prospective patients should contact each health care practitioner who will provide services in the ASC to determine the health insurers and health maintenance organizations with which the health care practitioner participates as a network provider or preferred provider.

The following providers are contracted with The Orthopedic Clinic Surgery Center to provide services for patients:

Space Coast Anesthesia Services, LLC
6225 N. State HWY. 161, Ste. 200 Irving, Texas 75038
Phone: 214-687-0001

Radiology Imaging Associates
1673 Mason Avenue, Suite 305
Daytona Beach, FL 32117
Phone: 386-274-7118

Additional information regarding health care quality measures and statistics provided by the State of Florida Agency for Health Care Administration can be found at https://pricing.floridahealthfinder.gov/.

Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

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, like a copayment, coinsurance, or deductible. You may have additional 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” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays, 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 plan’s deductible or 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. Surprise medical bills could cost thousands of dollars, depending on the procedure or service.

You’re 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 they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). 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.

Additionally, Florida law protects patients with coverage through a Health Maintenance Organization (“HMO”) from balance billing for covered services, including emergency services, when the services are provided by an out-of-network provider.

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

Additionally, Florida law also protects patients with coverage through Preferred Provider Organization (“PPO”) or an Exclusive Provider Organization (“EPO”) from balance billing for covered services provided at hospitals, urgent care centers or ambulatory care centers for (1) emergency services and (2) non-emergency services provided at an in-network facility by an out-of-network provider if the patient did not have the opportunity to choose an in-network provider. This protection only requires patients to pay their in-network cost sharing amounts.

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

You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.

Generally, your health plan must:

• Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
• Cover emergency services by out-of-network
• 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
• Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket

If you think you’ve been wrongly billed:

Contact The U.S. Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) or visit https://www.cms.gov/nosurprises/ consumers for more information about your rights under federal law.

The Florida Department of Financial Services, Division of Consumer Services at 1-877-693 – 5236 (1-877-MY-FL-CFO).

The federal phone number for information and complaints is: 1-800-985-3059.

Need Your Medical Records Released?
To request medical records, complete the online form below. You will be required to provide a valid email address and a government-issued ID.

When will my online medical record request be ready?
Your records will be ready in 5-7 business days from the receipt of your electronic request.

How do I check the status of my request?
Go to https://recordstatus.sharecare.com

How do I pay for my records and/or radiology images?
Go to https://payonline.hds.sharecare.com/#!/patients

For more information, visit our Patient Resources page.

The Orthopedic Clinic Surgery Center has received accreditation from The Accreditation Association for Ambulatory Health Care (AAAHC). The status as an accredited organization means The Orthopedic Clinic Surgery Center has passed a series of rigorous and nationally recognized standards for the provision of quality health care, set by AAAHC.

AAAHC is a private, non-profit organization formed in 1979, and a leader in developing standards to advance and promote patient safety, quality care, and value for ambulatory health care through peer-based accreditation processes, education, and research. Certificates of accreditation are awarded to organizations that are found to be in compliance with AAAHC Standards.

AAAHC currently accredits more than 6,000 organizations in a wide variety of ambulatory health care settings including ambulatory surgery centers, community health centers, medical and dental group practices, medical home practices, and managed care organizations, as well as Indian and student health centers, among others. AAAHC is also the official accrediting organization for the US Coast Guard. With a single focus on the ambulatory care community, AAAHC offers organizations a cost-effective, flexible, and collaborative approach to accreditation.

Per Florida Statute 381.026, Florida law requires that your health care provider or health care facility recognize your rights while you are receiving medical care and that you respect the health care provider’s or health care facility’s right to expect certain behavior on the part of patients. You may request a copy of the full text of this law from your health care provider or health care facility.

A summary of your rights and responsibilities follows:

Patient Rights:

• A patient has the right to be treated with courtesy and respect, with appreciation of his or her individual dignity, and with protection of his or her need for privacy.
• A patient has the right to a prompt and reasonable response to questions and requests.
• A patient has the right to know who is providing medical services and who is responsible for his or her care.
• A patient has the right to know what patient support services are available, including whether an interpreter is available if he or she does not speak English.
• A patient has the right to know what rules and regulations apply to his or her conduct.
• A patient has the right to be given by the health care provider information concerning diagnosis, planned course of treatment, alternatives, risks, and prognosis.
• A patient has the right to refuse any treatment, except as otherwise provided by law.
• A patient has the right to be given, upon request, full information and necessary counseling on the availability of known financial resources for his or her care.
• A patient who is eligible for Medicare has the right to know, upon request and in advance of treatment, whether the health care provider or health care facility accepts the Medicare assignment rate.
• A patient has the right to receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.
• A patient has the right to receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have the charges explained.
• A patient has the right to impartial access to medical treatment or accommodations, regardless of race, national origin, religion, handicap, or source of payment.
• A patient has the right to treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
• A patient has the right to know if medical treatment is for purposes of experimental research and to give his or her consent or refusal to participate in such experimental research.
• A patient has the right to express grievances regarding any violation of his or her rights, as stated in Florida law, through the grievance procedure of the health care provider or health care facility which served him or her and to the appropriate state licensing agency.

Patient Responsibilities:

• A patient is responsible for providing to the health care provider, to the best of his or her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to his or her health.
• A patient is responsible for reporting unexpected changes in his or her condition to the health care provider.
• A patient is responsible for reporting to the health care provider whether he or she comprehends a contemplated course of action and what is expected of him or her.
• A patient is responsible for following the treatment plan recommended by the health care provider.
• A patient is responsible for keeping appointments and, when he or she is unable to do so for any reason, for notifying the health care provider or health care facility.
• A patient is responsible for his or her actions if he or she refuses treatment or does not follow the health care provider’s instructions.
• A patient is responsible for assuring that the financial obligations of his or her health care are fulfilled as promptly as possible.
• A patient is responsible for following health care facility rules and regulations affecting patient care and conduct.

A Patient and/or Patient Representatives or Patient Surrogate should contact any of the following if you have a concern or complaint:

• The Orthopedic Clinic Surgery Center’s Nurse Administrator at 386-366-8181
• Office of the Medicare Beneficiary Ombudsman at 1-800-633-4227 or visit their website at: http://www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html
• The State Department of Health at 850-245-4444
• Florida Department of Health
  2585 Merchants Row Boulevard
  Tallahassee, FL 32399
• Agency of Healthcare Administration 1-888-419-3456 (Press 1)
• Florida Medical Quality Assurance Consumer Service Unit 1-888-419-3456 (Press 2)

Complaints may be registered with the department by phone or in writing.

Need Your Medical Records Released?

To request medical records, complete the online form below. You will be required to provide a valid email address and a government-issued ID.

When will my online medical record request be ready?

Your records will be ready in 5-7 business days from the receipt of your electronic request.

Patient Online Access Form: This is exclusively for patients and legal guardians with legal paperwork requesting a copy of their medical records.

https://submissionportal.hds.sharecare.com/lfserver/PatientRequest?ClientID=FL468

Requester Submission Portal: This option is for healthcare providers, attorneys or if you are requesting the medical records of someone other than yourself and are not the legal guardian.

https://myplatform.hds.sharecare.com/submission-tools/ui/pro?clientId=FL468

How do I  contact Customer Service?

You may call: 858-244-1811