Financial Information

For your convenience, we accept Visa, MasterCard, Discover, American Express, Health Savings Card, CareCredit and Sunbit.  We deliver the finest care at the most reasonable cost to our patients, therefore payment is due at the time service is rendered. If you have questions regarding your account, please give us a call.

FINANCIAL RESPONSIBILITY.

Patients who are 18 years of age or older are considered legal adults. Financial responsibility for services rendered is determined by the designated guarantor, not by age or insurance coverage. The guarantor is the individual who signs this agreement and accepts responsibility for payment of all charges incurred on the account.

INSURANCE BILLING.

As a courtesy, our office will submit insurance claims on behalf of the patient, as long as it is not Medicare. Insurance coverage is a contract between the patient and insurance carrier. Insurance payment is not guaranteed. The patient/guarantor is responsible for all charges not paid by insurance, including deductibles, non-covered services and denied claims.

FEE CHANGES & ESTIMATES.

Treatment estimates are provided as a courtesy and are not a guarantee of insurance payment. Fees are subjected to change based on treatment rendered and insurance determination.

RESCHEDULING.

If you need to reschedule your surgery within 48 hours of the scheduled time, a non-refundable $200 deposit will be required at the time of rescheduling and will be applied towards your surgery. All deposits collected will be valid for 6 months.

PAYMENT POLICY.

Payment is due at the time services are rendered. This includes any estimated patient portion not covered by insurance. At this time, we do not offer in-office payment plans. However, we do accept CareCredit and Sunbit. A pamphlet about CareCredit and Sunbit can be provided upon request. Our office also accepts cash, checks and all major credit cards without an additional fee.

RETURNED CHECKS / PAYMENTS.

A $35 processing fee will be collected for all returned checks. Payment for returned items must be made by cash, credit card or certified check.

OUTSTANDING BALANCE & TREATMENT HOLD.

Any outstanding balance must be paid prior to scheduling or continuing non-emergency treatment. The practice reserves the right to place a temporary hold on treatment until the balance is resolved.

STATEMENTS DELIVERY.

Billing statements will be sent by mail. It is the responsibility of the patient/guarantor to keep contact information current. Failure to receive a statement does not relieve financial responsibility.

COLLECTIONS.

Accounts that remain unpaid after 120 days may be referred to a collection agency. Accounts will be submitted under the name of the designated guarantor.