Financial Assistance Policy

If TLC Outpatient Surgery and Laser Center believes that you have health insurance and/or HMO coverage(s) that may cover some or all of the Services, TLC Outpatient Surgery and Laser Center may initiate contact with them to determine your cost-sharing responsibilities for TLC Outpatient Surgery and Laser Center’s bill. You may contact them directly as well for additional information concerning your cost-sharing responsibilities. If TLC Outpatient Surgery and Laser Center determines that you have cost-sharing responsibilities for TLC Outpatient Surgery and Laser Center’s bill, in accordance with TLC Outpatient Surgery and Laser 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. TLC Outpatient Surgery and Laser 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 TLC Outpatient Surgery and Laser 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 TLC Outpatient Surgery and Laser Center to be “charity care.” There is no formal application process for obtaining “charity care” at TLC Outpatient Surgery and Laser Center. TLC Outpatient Surgery and Laser 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 TLC Outpatient Surgery and Laser Center, you can receive a good faith estimate of anticipated charges for the treatment of your condition at TLC Outpatient Surgery and Laser Center. This estimate must be provided to you within seven (7) days of the request being received by TLC Outpatient Surgery and Laser 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 TLC Outpatient Surgery and Laser Center at 352-391-5875. 

Itemized Bill

Upon request and after discharge from TLC Outpatient Surgery and Laser 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 TLC Outpatient Surgery and Laser 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 TLC Outpatient Surgery and Laser Center. You may request a more personalized estimate of charges from these other health care providers by contacting the health care providers directly. TLC Outpatient Surgery and Laser Center may contract with providers for pathology and anesthesiology services; these services are billed separately from TLC Outpatient Surgery and Laser Center for their services. You may contact these providers through their contact information provided below.

TLC Outpatient Surgery and Laser Center Providers

Mid-Florida Pathology
120 East North Blvd. Suite 102
Leesburg, FL. 34748
1-352-455-2871 

St. Lucie Anesthesia Associates, LLC
PO Box 744883
Atlanta, GA 30374

Patient Health Record

Upon request and after discharge from TLC Outpatient Surgery and Laser Center, TLC Outpatient Surgery and Laser 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.

www.Floridahealthfinder.gov