Self – Pay Financial Requirements
Self-pay patients are required to pre-pay a down payment for the following amounts at check in:
(The price above is NOT the total cost for your visit or procedure - it is only the required down payment)
Resources for Financial Assistance
For all patients who need assistance in getting help for their medical bills the following resources are available for everyone who qualifies:
Our Practice Financial Policy
The following sets forth the general financial policy of Gastroenterology Associates of S.W. Florida, P.A. Please review this information and sign where indicated.
The patient is responsible to provide the office staff of Gastroenterology Associates of S.W. Florida, P.A. with current, accurate billing / insurance information at the time of check in and to notify Gastroenterology Associates of S.W. Florida, P.A. of any changes in this information. Any patient with insurance coverage that is a Medicare replacement plan and have a secondary insurance plan; such as Medicaid, need to be aware that the secondary insurance will not pay for any portion of the bill and the patient will be responsible to pay for any remaining balances after the Medicare replacement plan pays.
The specialist co-pay (which can be different than my Primary Care co-pay) is to be paid prior to services being rendered. I understand that this is a contractual agreement that I have with my health plan and that Gastroenterology Associates of S.W. Florida, P.A. also has a contractual agreement with my health plan to collect co-pays at the time of service, and they are required to report to the carrier any enrollees failing to pay the co-pay.
There is a $15 Statement Fee that will be charged to my account if I do not pay my co-payment on the day of the visit.
There will be an insufficient funds fee of $25 charged to my account if an insufficient funds check is given for payment. I further understand that to rectify my account, I will be required to pay with cash, a money order, cashier’s check, or credit card.
There is a $20 fee to complete disability paperwork associated with my care that will have to be paid prior to the forms completion. I further understand that if additional disability forms (such as FMLA) are required then and additional $20 fee is required and will have to be paid prior to the forms completion.
There is a $75 fee if I do not give two business days advance notice when cancelling or rescheduling for any radiology or endoscopy procedures.
Medical records request are handle by a third party company “Health Port”. There is a standard fee of $1 per page, plus shipping and handling fees. A properly signed medical records release will be required in order to get the copy of your medical records. If you have any questions about your request call Health Port at 1-800-367-1500.
I understand that Gastroenterology Associates of S.W. Florida, P.A. will verify my insurance eligibility, deductible amounts, and coinsurance amounts prior to any elective procedures that I may have. I further understand that it is the policy to collect the deductible and/or coinsurance prior to scheduling my elective procedure. I further understand that the FEE I AM QUOTED IS AN ESTIMATE based on the anticipated procedure to be performed and the current information provided to Gastroenterology Associates of S.W. Florida, P.A. by my insurance carrier.
I understand that I will be billed for any amounts due by me (co-payments/coinsurance amounts/deductible amounts) and that I have a financial responsibility to pay these amounts. I understand that I will be provided with three (3) statements for any balance due after insurance payment. I further understand that if I have not made payment after the third “Final Notice” statement being mailed that my account will be sent to an outside collection agency. I also understand that I will be responsible for any collection, interest or attorney’s fee’s associated with the collection efforts.
I understand that the staff of Gastroenterology Associates of S.W. Florida, P.A. may contact me at any phone number that is provided to discuss financial responsibility, unless I submit a written request to restrict certain phone numbers where I can be contacted.
I understand that Gastroenterology Associates of S.W. Florida, P.A. will obtain the necessary authorizations prior to rendering treatment. I further understand that prior authorization is not guarantee of payment, and that I am responsible for any bills not paid by my insurance carrier.
My signature below confirms that I have read and understand these financial policies and my financial obligation as pertains to the providers of Gastroenterology Associates of S.W. Florida, P.A.
On November 3, 2012 Dr Weiss and Staff participated in the Crohn’s & Colitis 1.2 mile walk, “Take Steps to be Heard” at Lakes Regional Park in Ft Myers. Gastroenterology Associates had taken donations for the Crohn’s & Colitis Foundation and will continue to support the cause. Barbara Cioffi our practice representative had set up a table for digestive awareness at the event and coordinated with physicians and staff to get involved. If you would like more information on this foundation or would like to donate to our team go to this direct link here.
On March 24, 2012 Dr Weiss, Dr Perez, Michele Robbins, PA-C and Staff participated in the Colon Cancer 5k run/walk, “Get Your Rear in Gear” at Hammond Stadium in Ft Myers. Gastroenterology Associates made donations for the Colon Cancer Coalition and will continue to support the cause. To see video slide show of the event click here. If you would like more information on this foundation or would like to donate to our team go to this direct link here.
Dr Perez has been featured in the Latino Press Release click the link to view the news article “The Latino American Who’s Who Recognizes Julian Perez M.D.”
We now have FREE Wi-Fi available in our Ft. Myers office and at Barkley Surgery Center for patients and their family members while they are waiting. Please see signs in the waiting room for logon information the next time you visit us.
Dr Perez has been featured in a new story – click the video link below to view now!Watch the Video
Congratulations to our newest Associate, Julian Perez, M.D., for obtaining his Board Certification in Gastroenterology!
We've been featured in a news story! - Health Matters: Detecting AVMs with a pill camera