Our financial policy disclosure and agreement is included in the Patient Registration Packet.
Below is a review of our policy:
Thank you for choosing Germantown Oral & Facial Surgery Center for your oral surgical care. We are committed to providing the highest standard of care at a reasonable cost. In order to avoid any misunderstandings, we ask that you review and sign our financial policies disclosure prior to agreeing to treatment.
Estimates for surgical services or verification of insurance coverage will only be provided after meeting with one of our surgeons to determine a treatment plan and becoming an established patient. This is the only way to ensure you receive accurate and appropriate information and care. Out of this concern for accuracy and transparency, we do not perform treatment unless we have provided you with an estimate of your fees. Please call us should you have any questions after receiving your estimate and we will gladly explain the breakdown of fees.
As a courtesy prior to scheduling your consultation, patients have requested understanding what the maximum out-of-pocket expenses could be (your insurance may or may not cover a portion) for a:
Dental specialist consultation $130
Medical specialist consultation (lesion or biopsy) $232
Panoramic radiograph $155
CT of the jaw(s) $250 – 450
We do not give estimates for extractions, implants, or any other services until you have been evaluated by one of our doctors to determine what you treatment plan requires.
Insurance: This practice participates with many different insurance carriers and their various plans. We try to keep up with the terms of each, but this is not always possible. We will work to maximize your insurance reimbursement for those procedures covered by your insurance plan. You are ultimately responsible for the payment of any remaining balance not covered by your insurance. It is your responsibility to know and understand your insurance policy and benefits as you are the one who has a contract with the insurance carrier. Nevertheless, as a courtesy, we will attempt to verify the insurance coverage, calculate an estimate of your financial responsibility, and provide you with this information before the day of surgery. The estimate is based solely on the information provided to us by you and your insurance carrier, and are not a guarantee from our office or the insurance carrier regarding the actual covered benefit for treatment. Actual benefits will be determined by your insurance carrier after the claim is submitted. We cannot and will not be responsible for any incorrect information provided to us by you or the insurance carrier. If you are concerned with the coverage, the safest thing to do is to check with the insurance carrier yourself or have us request a pre-determination of coverage. Please note that the insurance carriers consistently take 6 weeks or more to respond once we have submitted the pre-determinations request.
Even if prior authorization or a pre-determination is obtained, any insurance carrier has the ability to deny payment at a later date, claiming that the procedure is non-covered or not medically necessary. This might be due to an error on their part, an exclusion in the policy, or because of a change in the policy between the time the coverage is verified and the time the surgery is performed. It is also possible for the insurance carrier to determine that the coverage is no longer valid on the date that the surgery is performed. Should any of these unforeseen occurrences take place, you will become responsible for the full charges, regardless of what the initial estimate may have been. Denials by the insurance carrier are your responsibility to appeal for coverage. We do not file appeals. We will be glad to provide the treatment notes and information in order to file the appeal.
All payments are due and payable at the time of service. This includes charges for X-rays, co-pays, and surgical treatment. Our fees reflect the quality of care that we endeavor to give to each patient; as such, they are not negotiable.
- Cash, Check, Visa, Mastercard, Discover, American Express, HSA, FSA are accepted.
- Returned check: a $100 fee will be charged to the patient’s account.
- Care Credit: 6 month interest-free and all interest bearing plans. If interested, please arrange this with our staff prior to the day of your surgical appointment. This will not be arranged on the day of surgery.
- We do not arrange any other types of payment plans.
Regarding Divorce: We will not become involved in disputes between divorced parents regarding financial responsibility for their child’s medical/dental expenses or shared payment arrangements. The person who accompanies the child is responsible for the necessary payment, and agrees to be financially responsible for the care we provide to your child, regardless of whether a divorce decree or other arrangement places that obligation on your former spouse.
Failure of payment: A finance charge will be applied to all balances over 30 days old, including accounts with outstanding balances from insurance companies. The finance charge is 1.5% per month with an annual percentage rate of eighteen percent (18%). If it becomes necessary for our practice to use an outside means of collecting on the patient’s account (such as a collection agency, legal or court fees), you agree to be responsible for all additional fees incurred by Germantown Oral & Facial Surgery Center to collect on the delinquent account.
Missed or Late appointments: We make every effort to schedule and treat patients as promptly as possible, and patients who do not keep their appointments prevent others from receiving care promptly. A missed appointment occurs when you fail to notify our staff least 2 business days in advance of the appointment. A late arrival means arriving more than 15 minutes late to your appointment. Late arrivals may be worked in as quickly as possible while respecting the other scheduled patients’ appointments. We reserve the right to charge a $50 fee for each missed consultation and a $150 fee for each missed surgery appointment. Except in the case of emergent follow-up care after surgery, patients will not be rescheduled unless this fee has been paid in full. Patients who have 2 or more missed appointments within any given 12-month period or who have an excessive history of late arrivals, missed appointments, or a combination of the two will be subject to discharge from the practice.
Medicare/Medicaid: We do not participate with Medicare or Medicaid. We will not file these claims.
Insurance carriers require claims to be submitted in a timely manner. If you do not hear from your insurance carrier or us within two (2) months of treatment, please contact us. You will be responsible for any fees that have not been paid by your insurance carrier within three (3) months of the date of service, regardless of the reason. We will not become involved in disputes between you and your insurance carrier.