Billing Transparency

Patients may access the State of Florida’s Agency for Healthcare Administration website at this link for information about this facility:

Information about payments made to Lakeside Dental Surgery Center for defined bundles of services and procedures is available by using this tool at: Service bundle information is a non-personalized estimate of costs that may be incurred by a patient for anticipated services and actual costs will be based on services actually provided to the patient.

To learn more about the Price Transparency, Patient Billing and rule 59A-5:

Right to Request an Estimate

Patients have the right to request a personalized estimate from Lakeside Dental Surgery Center. Estimates are provided upon request of the patient or legal guardian for nonemergency medical services. This estimate may be requested by contacting the Facility Administrator at (904) 395-4840.

It is the facility’s policy to offer payment plans to assist patients who have difficulty paying outstanding balances in full at the time the accounts become due as a result of financial hardship. For inquiries regarding the facility’s financial assistance policy, charity care policy, and collection procedure, please contact:

Jessica Green
Facility Administrator
(904) 395-4840.

The purpose of the financial assistance, charity care, and collections policies is to provide the management of Lakeside Dental Surgery Center with a uniform method for handling patients who are financially responsible for all or a portion of their account but cannot pay in full as a result of financial hardship. This policy ensures that patients who cannot make payment in full at the time that the account becomes due have an alternative way to pay over a specified period of time.
Lakeside Dental Surgery Center encourages all patients to pay in full when services are rendered.  However, team members can create payment plans for patients unable to pay in full or who do not qualify for Care Credit, so that they may pay outstanding balances over time.  Payment plans may be used for outstanding balances or pre-service deposits for procedures, surgeries, or non-covered services. The minimum balance for a payment plan must be greater than $100 for the following to apply:
  • 50% of the balance must be paid at the time services are rendered
  • The remaining 50% must paid within 3 months in installments
A patient who has a delinquent account will be allowed one month to make up the missed payment.  If they fail to meet this schedule, the account is no longer eligible for a payment plan, and must be paid in full.  If the account is more than 120 days past due, it is made eligible for pre collection agency turnover.
Lakeside Dental Surgery Center does not currently offer formal charity care, should this change updates will be made.

Contract Providers

Please click the link below for a list of contracted providers at this facility.

Please contact the health care practitioners anticipated to provide services for your surgery with regards to a personalized estimate, billing practice and participation with your insurance provider or health maintenance organization (HMO) as the contracted practitioners may not participate with the same health insurers or HMO as Lakeside Dental Surgery Center.

As of the most recent update to this Disclosure, the facility has not contracted with any health insurer or HMO. The site will be updated when the facility becomes a network provider.

Out of Network

A patient receiving treatment at our surgery center under insurance with which our facility is out of network may be eligible to receive an adjustment to their assigned out of network patient liability, assuming our facility is not prohibited from offering Out of Network adjustments under state/Federal laws or your insurance company’s provisions. If not prohibited, the application of any out of network discount is subject to vary based on a patient’s benefit coverage. Accounts which become delinquent may have the adjustment disallowed.

To request an estimate, please call Lakeside Dental Surgery Center at (904) 395-4840.

Section 1557 of the Patient Protection and Affordable Care Act

Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). The law prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities. Section 1557 builds on long-standing and familiar Federal civil rights laws: Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973 and the Age Discrimination Act of 1975.

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A referral is required from your dentist or physician.