Financial Assistance Policy
If St. Augustine Endoscopy Center believes that you have health insurance and/or HMO coverage(s) that may cover some or all of the Services, St. Augustine Endoscopy Center may initiate contact with them to determine your cost-sharing responsibilities for St. Augustine Endoscopy Center’s bill. You may contact them directly as well for additional information concerning your cost-sharing responsibilities. If St. Augustine Endoscopy Center determines that you have cost-sharing responsibilities for St. Augustine Endoscopy Center’s bill, in accordance with St. Augustine Endoscopy Center’s financial assistance policies, you will be required to pay your cost-sharing responsibilities in full on or before the date that Services are provided. St. Augustine Endoscopy 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 St. Augustine Endoscopy Center, 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 St. Augustine Endoscopy Center to be “charity care.” There is no formal application process for obtaining “charity care” at St. Augustine Endoscopy Center. St. Augustine Endoscopy Center’s 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 St. Augustine Endoscopy Center, you can receive a good faith estimate of anticipated charges for the treatment of your condition at St. Augustine Endoscopy Center. This estimate must be provided to you within seven (7) days of the request being received by St. Augustine Endoscopy Center. 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 St. Augustine Endoscopy Center at 904-824-6108.
Itemized Bill
Upon request and after discharge from St. Augustine Endoscopy Center we will provide a statement within 7 working days of your request.
Provider Disclosure
Services may be provided in this health care facility by St. Augustine Endoscopy Center 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 St. Augustine Endoscopy Center. You may request a more personalized estimate of charges from these other health care providers by contacting the health care providers directly. St. Augustine Endoscopy Center may contract with providers for pathology and anesthesiology services; these services are billed separately from St. Augustine Endoscopy Center for their services. You may contact these providers through their contact information provided below.
St. Augustine Endoscopy Center Providers
Anesthesia:
St. Augustine Anesthesia Partners, LLC
PO Box 551132
Jacksonville, FL 32255
Pathology:
Borland Groover Clinic, P.A.
4800 Belfort Road
Jacksonville, FL 32256
Patient Health Record
Upon request and after discharge from St. Augustine Endoscopy Center, St. Augustine Endoscopy Center 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.
Patient Complaint or Grievance
To report a complaint or grievance, you can contact the facility Administrator by phone at 904-824-6108 or by mail at:
St. Augustine Endoscopy Center
40 Groover Loop Suite 100 St. Augustine, Florida 32086