Billing, Insurance & Payment FAQ
Have a question about your Sarasota Memorial bill? Below you will find some answers to our most commonly asked billing questions.
Have a Billing Question?
Our Patient Billing Advocates are standing by to help.
Call 941-917-1540 / 800-764-2455 (8am-5pm, Monday-Friday).
Visit our office at 1741 Main St., Sarasota, FL 34236.
How can I pay my Sarasota Memorial bill?
For your convenience, we offer several payment options:
Online – You may pay your bill online using Visa, MasterCard, Discover, American Express, or PayPal.
By phone – To pay using a check, Visa, MasterCard, Discover or American Express, please call 941-917-1540, Monday through Friday, 8 a.m. to 5 p.m.
By mail – If you are paying by check, please write your patient account number or patient name in the memo line, and mail your payment to:
Sarasota Memorial Hospital
P.O. Box 863414
Orlando, FL 32886
In person – You may pay your bill using Visa, MasterCard, Discover,check or cash at the following locations: Sarasota Memorial Hospital Cashier Office (1st Floor), 1700 S. Tamiami Trail, Sarasota, FL 34239; or, at the Patient Financial Services Office at 1741 Main St., Sarasota, FL 34236 (enter from back of building, not main entrance on first floor). You may also make a payment at the time you receive services at any of our outpatient facilities.
Which health insurances do you accept?
Click here for information on health insurance plans accepted at Sarasota Memorial. To verify the benefits of your plan, we recommend contacting your health insurance company directly, prior to receiving non-emergency care at Sarasota Memorial.
What if my insurance is out-of-network or I don’t have insurance?
If Sarasota Memorial is not part of your insurer’s provider network, contact the insurer by calling the phone number on the back of your insurance card and ask whether you have “out-of-network” benefits and what those benefits will cover. With some plans, out-of-network benefits may match in-network benefits.
If you are uninsured or under-insured, our team of benefit coordinators is ready to assist you. Click here to review our Financial Assistance policies and fill out an application online (application appears at the end of the policy document).
If you are concerned that you may not qualify for financial assistance, Sarasota Memorial also offers discounts through our “prompt-pay” option to patients not seeking reimbursement. Be sure to mention that you are seeking the “prompt-pay discount” when scheduling services or requesting a cost estimate for services.
How do I get an estimate for the cost of care?
For an estimate, call our Price Quote Line at 941-917-1447. IMPORTANT: SMH bases these estimates on the information you or your physician provide. However, additional needed services may impact the final cost.
Is there a way to know what out-of-pocket expenses I can expect?
While it’s easy to find information about hospital charges, it is difficult to predict how an insurer will interpret a claim. Each healthcare service has a corresponding code for billing. It’s unlikely that a patient will know the codes for needed service(s); however, you can sometimes find them on a physician order.
If you have insurance: Contact your insurer. Tell them the codes/services you will be having, and ask what your benefits are for those services. Also ask whether an authorization is required, and if so, whether one has been requested by either your physician or the care facility.
In this case, “benefits” mean specifics like the amount of your remaining deductible and out-of-pocket balance, and whether a co-insurance or co-pay amount will apply to these services. (These are explained in greater detail below.)
Be sure to confirm that the benefits apply to the particular service you may be receiving. Benefits may not apply in all situations — for example, whether or not you are admitted for a hospital stay — and it is important to clarify with the insurance company.
Once you have completed the above step, reach out to us for an estimate. This can be done at the time of scheduling or by calling the scheduling office (941-917-7322) or the Price Quote Line (941-917-1447).
IMPORTANT: An estimate is only as good as the information you or your insurance company provides. It is possible for your insurance carrier to provide us with outdated or inaccurate benefit information. Additionally, benefit exclusions are not typically sent over by insurance companies; so those you will need to know by reading your insurance plan summary document.
What is a limited benefit plan?
Limited benefit plans often set a maximum amount that the insurance company will pay for your healthcare expenses. These limits could apply per day, per service or per year. Many patients are unaware they have limited benefits, so it is always important that you check for such limits when changing policies or purchasing new insurance.
While our Registration team does its best to identify these plans, it is impossible for us to know the ins and outs of every individual plan.
What if my plan requires authorization/pre-certification and/or referral?
Authorizations/pre-certifications are essentially pre-approvals from the insurance company to cover a claim. However, insurance companies have made it clear that authorizations are not necessarily a promise to pay.
An insurance company likely will deny a claim if it was not alerted to the need for the service before it is provided and did not agree to cover it. HMOs and other plans often require referrals in order to cover visits to particular specialists or receive procedures. These referrals typically come from your Primary Care Provider (PCP). Our Financial Resource team is available to help you attain prior authorizations for certain services.
What should I do if insurance denies my claim?
Denials are how insurance companies delay paying and or refuse to pay a claim. The cost of most denied claims becomes patient responsibility.
Patients have the right to appeal denials and to present an argument in favor of coverage and overturning the insurer’s decision. You can appeal a claim denial using an appeal form, which often accompanies the insurer’s denial letter. If it does not, contact your insurance company to see how best to file an appeal.
Some denials can be overturned without appeal. For instance, denials related to Coordination of Benefits (when the insurance company feels it is not the primary payer on your claim) or not having a child/dependent on your plan can often be easily remedied by calling the insurance company and updating your records; however, you will likely still need to provide supporting documents.
If you have exhausted your appeal rights and the insurance company still refuses to process your claim, please contact our team and we will be glad to explore payment options and plans.
Why did I get a statement? I should have a zero balance.
There are a couple possible reasons for this. One possibility is that your prior payment was received and processed, but the statement went out at the same time. You can go online to confirm your payment or give us a call.
Another possibility for this is if we have not heard from your insurer, we often send patients an informative statement approximately 30 days after originally billing the claim. This helps to keep patients in the loop and often prompts patients to contact the insurer and expedites payment.
You are billing the wrong insurance. How can I update this?
Please call 941-917-1540 ( toll free: 800-764-2455) during normal business hours, and a team member will be happy to assist.
What are deductible, co-Insurance, co-pay and out-of-pocket amounts?
Deductible: This is the amount of money that you are responsible for paying, before the insurance company will begin paying. Your deductible does not apply to all services, so it’s always good to familiarize yourself with your health plan specifics.
EXAMPLE: A surgical procedure will cost $10,000, and the patient has a $2,000 deductible, and no co-pays or co-insurance that apply. The patient would be responsible for paying the $2,000 deductible first, and then the insurance company would pay the remaining $8,000.
Co-pay: This is a set amount you will have to pay for particular types of services. The most common co-pays are physician’s office co-pay, a specialist co-pay and an emergency room co-pay. Be sure to check your plan.
EXAMPLE: Visiting a particular specialist, a patient may have a $75 co-pay. This means that, for however many visits are covered under this patient’s plan, the patient will always pay only $75 for the appointment, and the insurance will then pay the remaining cost. However, if additional procedures are requested or conducted during the visit, additional co-pays and deductibles may still apply.
Co-insurance: This is the percentage of cost that you will owe after you have met your deductible.
EXAMPLE: If a patient with 40% co-insurance has a $10,000 bill after paying the deductible, the patient will still be responsible for paying $4,000 of that $10,000, and the insurance company will then pay for the remaining 60%.
Out-of-pocket: Typically, this is the maximum amount you will pay each benefit year, after which the insurance company will pay for the entire cost of procedures and visits covered by your plan. However, certain plans may not include deductible or co-pay payments in this amount.
EXAMPLE: A patient has a scheduled surgery valued at $20,000. This procedure is covered in their plan with a $2,000 deductible, a 20% co-insurance and a $4,000 out-of-pocket amount. First, the patient is responsible for the $2,000 deductible before insurance kicks in. Then, take the remaining $18,000 and apply the 20% co-insurance. This comes out to an additional $3,600 to be paid by the patient, and would bring their total to $5,600, but the patient has a $4,000 out-of-pocket limit. So, the patient pays up to the out-of-pocket limit and the insurance company pays the remaining $16,000.