Transparency in Coverage
& Good Faith Estimates

TRANSPARENCY IN COVERAGE

NO SURPRISES BILLING

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

GOOD FAITH ESTIMATES FOR SELF-PAY PATIENTS

Under the law, health care providers need to give patients who don’t 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.



*Download a copy of the HHS Notice and our estimates here:

• HHS Notice
• Good Faith Estimate for NEW Self-Pay Patients
• Good Faith Estimate for ESTABLISHED Self-Pay Patients

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HEALTH PLAN PRICE TRANSPARENCY

You have the right to know the cost of a covered item or service before receiving care.
For more information, visit https://www.cms.gov/healthplan-price-transparency

*The links below lead to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and include negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

PUBLIC DISCLOSURE LINKS

Insurance Carriers

• CIGNA
• CIGNA Transparency in Coverage Overview
• Machine Readable Files (available 7/1/2022)
• UHC
• UHC Transparency in Coverage FAQ
• Machine Readable Files (available 7/1/2022)

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SURGERY CENTER PRICE TRANSPARENCY

Surgical procedures are billed in three components: physician, facility and anesthesia.

FACILITY:

To learn more about facility pricing for procedures, please visit: https://pricing.floridahealthfinder.gov
• Please note, the service bundle information provided on the website listed above is a non-personalized estimate of costs that may be incurred by the patient for anticipated services. Actual costs will be based on services provided to the patient.
• Patients have the right to request a personalized estimate from the Eye Institute Surgery Center, LLC

PHYSICIAN:

Please contact the health care practitioner anticipated to provide services to the patient while in the Eye Institute Surgery Center, LLC, regarding a personalized estimate.
• James McManus, MD
• Jason Darlington, MD
• Gary Ganiban, MD
• Hetal Vaishnav, MD
• Matthew Adams, MD
• Regina Pappas, MD
• Alexandros Pappas, MD
• Jason Ross, MD
• Daniel Stingl, MD
• Rafael Trespalacios, MD

ANESTHESIA:

Please contact the anesthesiologist or CRNA that will be performing services at the Eye Institute Surgery Center, LLC for a personalized estimate of the anticipated services.
• JoJo MacDonald, CRNA