Insurance & Billing Information

Insurance and Billing Guidelines

Estimates … After meeting with our doctor and discussing the recommended treatment plan, our finance
department will work up an estimate. This estimate will include insurance procedure codes,
the description of procedures, and our standard fees (prior to any insurance contributions).

Pre-Authorizations … Your insurance plan is a contract between you, the patient, and your insurance company.
If you have questions regarding your benefits, please contact your individual insurance with
our estimate in hand. Patients are responsible for determining whether services are covered
under their insurance plans. Benefits are not guaranteed. Oral & Maxillofacial Surgery Fox
Cities does not automatically contact your insurance prior to your procedure. Some insurance
companies no longer accept pre-treatment estimates. We ask patients to be responsible for
knowing their insurance company’s guidelines and follow through with any special
requirements. We are happy to assist if your insurance requires pre-authorization on a
certain procedure, upon patient request.

Insurance Companies … As a specialty practice, we see patients with many different types of insurance
policies. We can file claims to most insurance companies, although we may not be considered
preferred in-network providers with all companies. We cannot quote your actual insurance
benefits due to the variance between medical and dental insurance plans. We are not
providers for state Medical Assistance and government Marketplace plans, and we cannot file
claims to those entities.

No Surprise Billing… Your treatment plan will indicate if your insurance company given at the time of
evaluation is contracted as in-network 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 treatment is
consented for an out-of-network provider, the provider is allowed to send a balance bill (the
difference between what insurance paid and what the doctor charged). Patients may then be
financially liable for significantly more than if they had insisted on care by an in-network
provider.

Medical vs. Dental Insurance … As oral surgeons, we must file all of our claims to medical insurance first and
dental insurance second. Most medical plans tend to exclude tooth related procedures, but
may allow some coverage for oral biopsies, TMJ, and accidental dental. Many dental plans
offer some benefits for tooth related services, however your plan may have limitations such
as annual maximums, waiting periods, and non-coordination policies (specifically with high
deductible medical plans). We recommend that you look into your individual plan for
covered benefits.

Medicare … Medicare plans have oral surgery limitations, and they do not cover the treatment of teeth
and/or gums. Certain oral biopsies and injuries may have some coverage, but benefits cannot
be guaranteed.

Sedation Options … Oral & Maxillofacial Surgery Fox Cities offers various forms of sedation options to our
patients. Please note that sedation for certain procedures may not always be considered
medically necessary by your insurance or be covered under your plan.

Oral Pathology … Some oral surgery may include biopsy or lesion excision. In these cases, a specimen is often
sent to an outside lab for analysis. You will receive a separate billing invoice directly from the
lab. Please alert our office if your insurance has specific lab requirements.

Payments … Insurance coverage varies widely from plan to plan and cannot be guaranteed. Our office
requires a 20% down payment from patients that carry both medical and dental insurance on
the day of surgery, along with a completed Final Payment Arrangement form. For those
patients who are uninsured or fall into our non-covered benefit category (this includes
medical insurance only, dental implants, and appliances), we require payment in full at the
time of surgery. For all treatment plans over $6,000, we require a 50% deposit one week
prior to surgery with the remaining due at time of surgery. All payments in full qualify for the
5% discount (except in instances of 100% insurance coverage, multiple insurance ppos, or
using CareCredit). We accept cash, check, Visa, Master Card, Discover, and/or American
Express. Please make sure to inquire with your financial institution if you have daily spending
limitations.

CareCredit … CareCredit is an outside financing option that our office offers to our patients. Upon credit
approval, there are flexible deferred interest payment plans available for out-of-pocket
expenses. Patients can easily apply in person at our office, online (CareCredit.com), or by
phone at 800-365-8295. CareCredit payment options are exempt from our 5% pay in full
discount.

If you have any questions regarding your financial obligation, please reach out to our billing department at 920-739-1214.