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Financial Policy

south florida maxillofacial services

Any patient in need of maxillofacial surgery should be assured of the best care at the most reasonable cost. Whether you have insurance or not, we are committed to providing you the very best of care for your maxillofacial surgical needs.
If you do have insurance, we may ask you for partial payment of the full price of the treatments that we have agreed on, and if you do not have insurance, we do ask that payment be made at the time the services are performed. We do accept cash, Visa, Discover and MasterCard (debit or credit), American Express as well as Care Credit.


When we do ask for partial payments (when you have insurance) you can rest assured it will be based on what we know your insurance will cover and it will be a portion of the total fee. You are responsible for payment of any balance whether your insurance company has reimbursed us or not.

 

Our financial coordinators are happy to help you submit your insurance claims and can help you by providing information on third party dental financing agencies.

 

Our financial policy has been created so that you are aware of the availability of options we offer. Please request a copy of our policy before you receive any of our services.

 

 

OMSA Financial Policy

Payment Methods Available:

 

Cash
Credit Cards: Visa, MasterCard, Discover, American Express
Registered Checks
Money Order
Care Credit

 

Payment is expected as services are rendered unless prior financial arrangements have been made.

 

NSF Checks or collection Accounts:
Due to unfortunate previous situations we do not accept checks as payments to our service. If in the event of an exception, we charge a $35 collection fee for non sufficient funds check and a $40 collection fee for accounts over 90 days that are sent to our outside collection agency.

 

Insurance:
Our courtesy services to you includes electronically filing your insurance within 24 hours of your appointment so that
benefits may be paid directly to our office. Researching your dental/medical plan to advise you of benefits available to you and following the American Dental Association guidelines for coding and electronically ’filing insurance claims.

 

We try our very best to accurately estimate your portion on the date of service based on the information given to us by your insurance carrier. It is not until payment is received by your insurance carrier when we have a better calculation of your balance due to our office. However, sometimes there is a need to send you a statement, which will be mailed to you the same day payment is received from your insurance company for your visit and/or surgery.

 

Our expectation of you as the owner of the policy is to make payment in full of fees or co-payments not covered by your insurance plan at the time services are rendered. We also ask that you understand that the policy belongs to you and we have no leverage to obtain payment from your insurance. With that, we ask that you take responsibility for payment of your visit should your insurance company not pay within 75 days of your appointment date. In order to avoid this situation, we ask that you keep our office informed of any changes in your insurance coverage or employment.

 

Every dental insurance policy has a maximum benefit, which we are able to track for services rendered in our office. If you have received care by another office, we cannot be responsible for calculating your remaining benefits accurately. You may call your insurance company to receive an updated amount after services have been paid to all offices involved. Any information from the insurance is a guarantee of payment. 
As for medical insurance, it is your responsibility to cover your co pay or annual deductible before any procedure is
performed. It is OMSA’s policy to charge medical co-pays or co-insurance considered for the procedure as a pre-
authorized charge in any of your credit cards that you provide for payment. When payment is received by your medical Insurance, we proceed to make the necessary adjustments and correctly adjust your balance due to our office with the credit card you left for such transaction.

 

Emergencv Patients:
There is to be one method of payment ONLY for emergency treatment of a patient that is new to our office. Patients
must pay at the time of service until they have been established as an existing, participating patient and then payment policies will apply.


Courtesies:

 

• Payment in full at time of appointments receive a 10% cash or credit card and Care Credit receives a 5% courtesy, on treatments exceding $300; 2,500 - 5,000 15% cash and 10% Credit Card and more than 5,000 to be discussed.
• Senior Citizen courtesy of 10% at time of services.
• Care Credit Plan — Patients can use CC Interest Fee Option for short term financing of amounts between $300 -
$25,000. Patients will be charged a retroactive finance charge if payment is not completed within the specified
time frame. The Flexible Payment Option also provides a payment plan for up to 60 months at a fixed interest rate.

 

Minors with separate parents:

 

The parent that brings the child to our office is responsible for paying the co-payment full fee. This parent will also be responsible for collecting payment from the other parent. Our office will not get involved in any situation regarding responsibIlity for payment other than the accompanying parent who brings the child to the office.

 

Unaccompanied minors

 

Non-emergency treatment will be denied unless arrangements for payment on a pre-authorized credit card are made prior to the appointment date and time.

 

Short Notice Cancellations and Broken Appointments:

 

A $50 fee will be placed on account for patients who have a broken appointment, a no-show or short notice
cancellation. This fee will be adjusted back out for first time offenders and a statement will be created and sent to them so they can see there is a charge but it has been waived this initial time. However, every subsequent appointment that is cancelled or broken will have the charge applied to the account but will not be waived. When surgery is scheduled, we request a $200 deposit for the use of our office surgical facility. This amount becomes part of your payment responsibility and will not be charged as an additional expense. However, if you fail to cancel your surgery 48 hours prior to the procedure, this same amount will be included as an additional fee for service and will not be waived.

 

I hereby authorize Dr. _____________ to release to my insurance company, information acquired in the course of my dental or medical care. I hereby authorize benefits to be paid directly to Dr. _____________ . I understand I am
responsible for any unpaid balances. I agree to be responsible for dental or medical services not paid by my dental or medical benefit plan. I have read and agreed to this Financial Protocol.

 

Thank you for understanding our Financial Policy and please feel free to ask any questions or voice any concerns you may have regarding it.

Patient Signature:____________________________________ Date: