Financial Information
We are very concerned about the cost of health care. Our goal is to provide the best treatment available at a reasonable cost. Thus we appreciate and expect payment upon the day of service and/or prior to certain operative procedures.
FILING OF INSURANCE CLAIMS
We are happy to file insurance claims for you as a courtesy, one time only. Ultimately, you are responsible for any issues or remaining balances with your insurance company because the contract is between you and your insurance company. If for some reason your insurance does not pay within 90 days, the remaining balance is your responsibility and interest will begin to accrue. The best way to prevent surprises with your insurance is to spend the time prior to your surgery reading your policy and inquiring about the type and extent of benefits provided.
All patients are required to pay at least the estimated portion based upon the estimated co-insurance expenses. If the insurance company pays more than anticipated, you will be refunded the overpaid amount. If there is a balance owing, you will be responsible for paying the balance in full within 10 days.
PRIVATE PAY
If insurance is not to be billed, then you are responsible for all cost of surgical services rendered. All fees are due on the day of service.
LATE FEES/INTEREST CHARGES/FEES
All fees are due on the day of service. A late fee of $25.00, re-billing fees and/or interest charges (calculated at 1% per month) may be assessed. These charges will be applied to all accounts with balances that are overdue past the 1st notice.
CHANGE IN TREATMENT PLAN
At times it may be necessary to modify your treatment. Change(s) may result by a decision by you and/or the doctor before treatment. Changes(s) also may result due to unforeseen medical or physical conditions, complications, and/or emergencies. When your treatment is changed, your fees and costs may change accordingly, of which you will be informed.
AUTHORIZATION TO ASSIGN BENEFITS TO PROVIDER
In order to allow you to pay only the estimated co-pay in lieu of full payment, you agree and authorize your insurance company to assign payment of any benefits for services rendered by Northwest Oral & Maxillofacial Surgery, P.S. to this office.