Patient Financial Services

Sarasota Memorial is committed to providing our patients with the information they need to make informed health care decisions. Our Patient Financial Services team is here to help you understand your financial responsibility for medical services, and help with financial aid options when needed. 

Following is a summary of services we provide: 
 

• Pre-Arrival Services – After you or your care provider tells us about a service or procedure you need, our Registration staff will contact you for personal and insurance information. Please bring your insurance card with you to your appointments.
• Direct billing to insurance providers – Prior to billing patients, we bill your insurance company, including but not limited to governmental plans, commercial health insurance, PIP auto insurance, third-party liability insurance, Medicare/Medicaid replacement plans, and any secondary insurance, based upon the information you provide and in accordance with applicable regulations and insurance company guidelines.
• Patient billing statements – At the same time, we send you billing statements so you are aware of any insurance activity. The statement will show that the balance is pending with insurance. You will receive monthly billing statements show the most current balance you owe until all payments are made by the insurance company or by you.
• Financial counseling & customer service – Our team is happy to answer your billing questions, help with payment issues, assist with financial aid programs, or arrange for an interpreter.
• Written estimates – Patients can request a personalized estimate for scheduled services. Call 941-917-1447 email PriceQuoteLine@smh.com for a written estimate. 
• Patient Assistance Programs – Our team also can help address the financial needs of uninsured patients and those who are underinsured or have an insurance plan that is not contracted with Sarasota Memorial. Click here for more information. 

Billing Advocacy: For any billing inquiries or concerns, please reach out to our dedicated Billing Advocacy Office at 941-917-1540 or toll-free (800) 764-2455, weekdays, 8:00 a.m. - 5:00 p.m., or email billing-inquiries@smh.com. Our specialized finance team is equipped to handle all billing-related matters with professionalism and care.

Protection Against Surprise Medical Bills: You have rights and protections against surprise medical bills. When you receive emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. For more information, click here. 

Newborn Babies: Newborn babies are usually eligible for coverage under your hospitalization policy, if they are added to your policy within 30 days of birth. It is your responsibility to contact your employer and your insurance carrier to enroll your child. If you are covered by Medicaid or Medicaid-related insurance, you must add your newborn to your Medicaid case.

Referrals and Authorizations: Most insurance companies require that your primary care physician refer you to receive specialty care. Each plan is different, and it is your responsibility to know the requirements of your plan and obtain any necessary referrals. You may be responsible for payment or your appointment may have to be rescheduled if you do not get the necessary approvals. Many insurance plans also require prior authorization for services. If your insurance company does not approve your care, we will notify you in advance and you will be responsible for payment, should you choose to proceed with services.

Collection Procedures: Sarasota Memorial staff will ask patients to pay estimated co-pays, co-insurance and deductibles prior to or at the time of your health care services. After your services, Sarasota Memorial will file a claim for insurance coverage in accordance with applicable regulations or insurance company guidelines. Once the claim has been processed by your insurance company, Sarasota Memorial will send you two billing statements. If the billing statements are not settled, Sarasota Memorial will refer the account to an external, contracted business office to follow up. The external business office can assist you in establishing a payment plan. If payment is not received by the business office, the account balance will be sent to a collection agency.  The collection agency also can help you establish a payment plan. Establishment and continued payment of agreed-upon payment terms will avoid any outstanding amounts being reported by the collection agency to a credit bureau. 

Transparency Tools: Information on Hospital Prices & Quality

Sarasota Memorial is committed to providing transparent information on quality and pricing. The state of Florida offers the Florida Health Finder website (https://healthfinder.fl.gov/), which provides hospital quality and performance information. The state also offers a site for data on health care costs and pricing.

The pricing website (https://price.healthfinder.fl.gov/#!) provides information on payments made to facilities for defined service bundles and procedures. The service bundle information is a non-personalized estimate of costs that may be incurred by the patient for anticipated services. Actual costs will be based on services actually provided to the patient. (The most accurate way for patients to determine their out-of-pocket cost for a service or procedure is to request a personalized estimate from Sarasota Memorial; please call 941-917-1447 or email PriceQuoteLine@smh.com). 

Charge Description Master (CDM): The federal government requires all hospitals to make public a list of their standard charges via the Internet, through a format such as the Charge Description Master (CDM), as well as a list of standard charges for each diagnosis-related group (DRG). The CDM— a database of all billable items and services  — and the list of diagnosis-related group charges are provided on Sarasota Memorial’s website for information only. These are not effective tools to help accurately estimate or determine what patients will pay for care. Charges in the CDM and the diagnosis-related group list do not reflect actual payments from patients, insurance companies and other payors for health care services. Actual reimbursement to Sarasota Memorial is affected by a number of factors, including (but not limited to) health plan rates, Medicare and Medicaid rates, and prompt payment discounts. The cost of care also may vary from patient to patient for the same service depending on any complications or different treatments provided because of the patient’s health. Whether a procedure was performed on an inpatient or outpatient basis also influences actual reimbursement.  

Sarasota Memorial’s CDM is available here. Sarasota Memorial Hospital-Venice’s CDM is available here

Certain physicians providing care at Sarasota Memorial may bill separately from the hospital. Sarasota Memorial’s CDM does not include those physicians’ fees. (See “Additional Billing Information” below.) 

Additional Billing Information

Sarasota Memorial patients will receive care from SMH and its affiliated healthcare providers. Because of this, patients could receive bills from multiple providers for the services rendered. These affiliated health care providers might or might not participate in the same insurance plans as SMH. We encourage patients to contact their physicians or their insurance company to determine provider health plan participation and to ask for information about possible non-SMH costs.