Financial Assistance Policy

South Miami ASC will verify your health insurance benefits prior to surgery and bill your carrier following your procedure. Estimated patient responsibility of co-pay portions, deductibles, and/or out of pocket fees are expected on the day of surgery. We accept cash, credit cards, and personal checks. We also are able to offer financing of your portion of the bill through Care Credit, an organization established for this purpose. If you are unable to pay your portion of the bill, we may be able to set up a payment plan. Discounts or cash pay prices may be offered if you do not have insurance or if your procedure is not covered by your plan.

Charity care is offered on a limited basis and you must qualify by completing the Financial Assistance/Charity Application which will be provided upon request.

Charity Care Policy


South Miami ASC is committed to providing Health Care Services to patients in Miami-Dade County and surrounding service areas regardless of their ability to pay. The Charity Care Policy was established to provide financial relief to those who are unable to meet their financial obligation to South Miami ASC.

Charity Care applies to charges for traditional, non-elective healthcare services to patients meeting the financial criteria set by the Surgery Center using the Federal Poverty Income Guidelines found at


All outpatient accounts are eligible for uncompensated care consideration. A Charity Care Application must be filled out by the patient/guarantor. Eligibility is based on income, family size and cash assets.

A. Patients with current Medicaid benefits having a procedure not covered by Medicaid, and not cosmetic in nature, will be approved for charity care based on their qualification under the Medicaid program. Proof of current Medicaid eligibility will be verified prior to approval.
B. Patients at 150% or less of the current Federal Poverty Income level, from all sources, will qualify for Charity Care with completed application.
C. Patients at 151% or higher will be considered for Charity Care on a case by case basis with completed application.


South Miami ASC may require some or all of the following documentation based upon the individual Charity Care Application

Required Documentation

A. Proof of Income – from all sources, listing gross income for the most recent four-week period.

B. Copies of most recent Federal Income Tax Return.

C. Last two months on bank statements for savings accounts and checking accounts.

D. Cash balances as of the date of service from certificates of deposit, stocks and bonds.

E. Number of dependents. Unborn children are not added to the family size. Death of a spouse or dependents will only be included in family size for the year of the death.

Other Documentation at the Request of South Miami ASC

F. Assets including home, automobiles, boats and real estate other than primary residences.

G. Monthly household expenses as well as loan payments.

H. Credit Bureau check on accounts balances of $2,000 or more.

I. Board of Assessment – Property Value check (as required).


A. Applicants for charity care will complete a charity care application. South Miami ASC reserves the right to check the veracity of the information at their discretion.

B. South Miami ASC prefers that the application be completed prior to or immediately following the date of service but will accept applications within 90 days from the date of service. The surgery center reserves the right to grant extension to the time frame cited and to deny an application if received after an extended period of time.

C. Loss of employment will be considered temporary until nine months have elapsed and will not be considered in the income evaluation.

D. Cash balances above the criteria will be applied to the outstanding balances first then the applicable reduction will be applied to the balance.

E. Incomplete applications will be returned unprocessed. Applications sent to the guarantor/patient at their request must be returned within 30 days to be considered.

F. The surgery center reserves the right to review benefit determination if financial circumstances have changed substantially.


A. Completed application (and supporting documents) is reviewed and a determination of eligibility is made within 30 days. Written notice of determination is forwarded to the guarantor/patient. Copies of all documents are kept in the patients chart.

B. Charity Care charges are entered into the patient accounting system and then written- off at the same time. The comment section of the patient accounting system should document this occurrence and the reasons for the anticipated charity handling.

C. If patient is Medicaid eligible, application to Medicaid must be completed and eligibility determined before consideration for assistance.

D. Current account balances will be the basis for consideration for assistance; previous balances that have resulted in bad debt classification will not be considered.

E. Each application is effective for accounts listed as well as future service that occurs within 180 days of the last approved application. A complete application would have to be completed for services that occur after the 180-day limit.

F. Applications are considered confidential in nature, the property of South Miami ASC, and will be retained for a period of seven years.