Financial Information

5% Savings:
To assist our patients with their treatment cost, a 5% reduction of treatment plan fees applies when payment in full is received at the time of service (this discount is not available to patients with 100% insurance coverage, with insurance plans that offer greater ppo discounts, or with accounts using CareCredit). Our office accepts cash, check, Visa, Master Card, Discover, American Express, and CareCredit.

Insured Patients:
Insurance plans are a contract between the patient and the insurance company. Insurance coverage varies widely, and benefits cannot be guaranteed. Patients should contact their individual insurance companies if there are questions on plan benefits and coverage. For patients that have both medical and dental insurance, a 20% down payment of the estimate total will be required at the time of surgery. In addition, a Final Payment Arrangement form (secure credit card authorization for payment on balances after insurance) will need to be completed to avoid monthly service charges on balances not paid in full. Insurance claims are filed if complete insurance information is provided to our office. Any remaining balance after insurance has processed is the patient’s responsibility. If there is a credit or overpayment on the account, a refund will be issued.

Non-Covered Benefits:
For accounts with no insurance, medical insurance only, dental implant procedures and/or appliances, full payment is required at the time of service. This makes patients eligible for a 5% discount. If there is a credit or overpayment on the account, a refund will be issued.

Treatment Plans over $6,000
Many insurance plans have annual maximums and limitations on coverage for large procedures. For any treatment totaling more than $6,000, we require payment in full prior to surgery. Our office will require a 50% deposit at least one week prior to your reserved appointment, and the remaining balance will be due on the day of surgery. Patients are still eligible for the 5% discount, with exceptions stated above. After insurance processing, if there is a credit or overpayment on the account, a refund will be issued.

No Surprise Billing
All patients are provided with an estimated treatment plan after their initial evaluation. This estimate will include insurance procedure codes, the description of procedures, and our standard fees (prior to any insurance contributions). Treatment plans will indicate if the insurance company given at time of evaluation is contracted as an in-network provider with Oral & Maxillofacial Surgery Fox Cities. In-network provider adjustments can only be taken if Oral & Maxillofacial Surgery Fox Cities, S.C. has signed a direct agreement/contract with that insurance organization. If the patient’s insurance is not listed as an in-network provider, the patient is consenting to be treated by an out-of-network provider which is allowed to send a balance bill (the difference between what insurance paid and what the doctor charged) for any remaining payments. Patients may then be financially liable for significantly more than if they had insisted on care by an in-network provider.

Workers’ Compensation:
If the services received are due to an accident or injury at work, please inform our business staff. Our office will assist with filing claims if complete information is provided. The collection of fees through Worker’s Compensation, personal injury, auto accidents, or other litigation is the patient’s responsibility.

Surgery Cancellations:
Please provide our office a 24-hour notice in the event you need to reschedule your procedure.  This allows us the opportunity to provide care to another patient.  A “No-Show”, “No-Call” or missed surgery appointment, without proper 24-hour notification, may be assessed a $150 fee.  This fee is not billable to your insurance.  If you are more than 15-minutes late to your appointment, arrive without following the pre-operative instructions, or fail to provide the required payment, the surgery may be cancelled and rescheduled.  Multiple no-shows or cancellations may be grounds for dismissal from the practice.