Payments & Insurance
Financial Policy / Insurance Information
At Oral & Maxillofacial Surgical Consultants, we make every effort to provide you with the finest surgical care and the most convenient financial options. To accomplish this, we will work with you to maximize your insurance reimbursement for covered procedures and find a payment option that works best for you.
It is the responsibility of the patient or the patient’s responsible party for all charges incurred, regardless of insurance coverage.
We offer the flexibility of cash, check, Visa, MasterCard, Discover, and American Express. Financing options are also available.
Our surgeons perform an evaluation prior to your treatment. This exam may occur at a separate appointment, but is often performed on the same day as surgery. Please be aware that there are fees associated with your consultation that may not be covered by your insurance. Not performing an evaluation prior to treatment would compromise the care of our patients. Our practice does not compromise our standard of care because of insurance benefit limitations.
If you are covered by insurance, you are required to pay a portion of your total expenses. This initial payment is due on the day of your surgery and shall not be deemed as payment in full.
If there is no insurance coverage for your surgery, payment in full is required on the day of your service. We will assist you with financial arrangements if needed.
As a courtesy, we will file your insurance claims for you, provided that you supply us with complete and accurate information. Please remember that insurance is considered a method of reimbursing the patient for fees paid to the doctor and is not a substitute for payment. Some companies pay fixed allowances for certain procedures and others pay a percentage of the charge. It is your responsibility to know your plan(s) benefits, if any, and to pay any deductible, co-insurance or any balance not paid by your insurance company.
You may have benefits for your surgery through your medical and/or dental insurance, or no coverage at all. Because of this, we ask you to call your insurance company prior to surgery to verify your benefits (i.e. deductibles, limitations, exclusions and yearly maximums).
If your insurance company does not process your claim within 60 days, you may be billed directly for the full fee. To ensure prompt processing, we encourage you to check the status of your claim with your insurance company.
Please note that insurance is a contract between you/your employer and the insurance company. You are fully responsible for all fees and charges regardless of your insurance coverage.
An estimate of the charges for your surgery will be given to you upon request. A current x-ray is necessary for us to give you a complete estimate of our fees.
Some insurance plans allow a pre-determination to be processed prior to treatment, generally processed within 2-4 weeks. Although not typically mandatory, your specific insurance plan may require a prior authorization; it is your responsibility to inform us so we can assist you in this process.
Good Faith Estimate (GFE)
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises
HMO or ACO Patients
If services provided are considered under your medical insurance, (biopsies, cysts, TMJ, infections, jaw deformities) and you are a member of an HMO, you must have a referral from your primary care physician. A referral from a dentist is not adequate for medical insurance consideration. Obtaining a medical referral is the patient’s responsibility. We cannot obtain the referral for you, and the referral may not be able to be obtained retroactively. If you do not have a referral, your medical insurance company may deny your claim or process it as “out-of-network”.
Medicare pays us directly for your care. You are responsible for any deductible and co-insurance. Medicare does not cover dental procedures (extractions, implants). If Medicare denies your procedure, you are responsible for the charges.
You will receive a monthly statement from us while your insurance is pending. Most insurance companies will respond within 2-4 weeks. Any remaining balance after your insurance has processed is your responsibility. Your payment is expected promptly.
If you are unable to pay in full, payment arrangements may be approved ain accordance with credit and collection procedures, as authorized by a Financial Coordinator. A 1.5% service charge (18% annually) will be added to any balance over 90 days.
Financing is provided by Lending Club or Care Credit with approved credit. More information is available about payment plans and Financing Options here.
Overpayments will be refunded to the appropriate party. Patient refunds will be automatically issued after all insurance processing is finalized. Refunds less than $1.00 will be issued upon request.
You will be responsible for all collection costs (which may be up to 42% of your balance), attorney’s fees and court costs. Delinquent accounts will be sent to an outside agency for collection.
Appointments that are cancelled or rescheduled within 24 hours, including no-shows, may be assessed an administrative cancellation fee of up to $100.