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Phone: 407-264-9633

Fax: 407-264-9959

Financial Assistance Policy

SUBJECT:  Financial assistance for patients who cannot afford to pay

PURPOSE: To assist patients in receiving services if they meet the financial requirements of the National Poverty Level or are financially indigent.

SCOPE: All eligible patients

POLICY: Patients who are unable to pay for services at Sand Lake Surgery Center may request an estimate of charges for a needed procedure and an assessment of their eligibility for financial assistance.


  1. All copays and deductibles are due prior to surgery at Sand Lake Surgery Center
  2. If the patient is unable to pay this amount, Care Credit is available and allows monthly payments to be made.  For the application process, go to CareCredit.com.
  3. If the patient requests evaluation for further assistance,
    • The patient will be asked to provide a copy of their Federal Income Tax Statement and a current payroll stub.
    • The National Poverty Level Sliding Scale will be reviewed to determine where the patient’s income level falls
    • If the patient meets or is below the gross income amount of the national poverty level, the appropriate write-off is made applicable to the procedure charge amount.
    • Collections Procedure
      • A statement of account will be sent every month for three months.
      • After 90 days a final statement will be sent allowing 10 days to pay.  If no payment is received after the 10 days have passed, the account will be sent to collections.