PATIENT FINANCIAL RESPONSIBILITY POLICY

Thank you for selecting Heritage Oral Surgery & Implant Centers for your treatment.  Our objective is to provide you with outstanding care.   For this reason, we want to provide you a thorough understanding of our patient responsibility financial policy.

The fee for our oral surgery treatment is based upon the complexity of your treatment plan.  We will review the fees associated with your treatment plan after our doctor has performed a thorough evaluation of your case. During the review of your treatment plan, if you have insurance, you will have the option to choose from 3 different billing processes that fit your specific needs.  Payment is due for all services rendered on the date of service.

Dental Insurance Coverage

It is your responsibility to be aware of your insurance coverage, policy provisions, frequencies, exclusions, limitations as well as authorization requirements.  This information is furnished by your insurance carrier which you may call at any time. We emphasize that as a dental provider, our relationship is with you and not with your insurance company.  It is your responsibility to know your own policy.

If you have dental insurance coverage, please provide all dental insurance information prior to service and our office will assist you with filing your insurance claim.  We are not your insurance provider, we provide a service and as a courtesy to our patients, we will provide an ESTIMATE only if that is the process you decide to move forward with and we will process the claim on your behalf for the services we rendered to you but all financial responsibility for your insurance coverage such as denials to frequencies, limitations to name a few are your full responsibility.  Please understand that we will provide an insurance estimate to you, however, it is not a guarantee that your insurance will pay exactly as estimated. Your insurance company and your plan benefits ultimately determine the amount paid. For the most accurate determination of your coverage, we offer to preauthorize your diagnosed treatment or pay 100% of the full fee for service upfront and we will send the claim for review.  Once your insurance carrier reviews your claim, if and any refund is due back to you, it will be refunded in the original method of payment.

It is important to recognize that once we file your insurance claim, we are not responsible for claims that are denied by your insurance for any reason. The patient is responsible for any balance due if a claim is denied. Please keep in mind that this is only an estimate and coverage verification does not guarantee

payment. It also does not guarantee the estimated cost given to you is the total amount due. You agree to pay the balance not paid by your insurance company for all services rendered to you by our providers.

You are responsible for all payments for treatment we provided to you, regardless of insurance coverage and determination.  Our office will bill your insurance as a courtesy to you but the ultimate responsibility for payment remains with the patient or legal guardian.

Non-Covered Services

All patients are responsible for non-covered services if denied by their insurance carrier.

Accepted Form of Payments

We accept the following forms of payment: Cash, Debit, Credit and Checks up to $1,000.  There will be a $50 charge for any checks returned for insufficient funds. We also reserve the right to refuse this form of payment in the future. Starting January 22, 2024, for use of a credit card, you will be responsible for a 2.3% reimbursement and/or recovery of credit card and/or merchant fees and expenses as incurred by the Practice.  Such additional charges and expenses will be included in your invoice from the Practice for payments processed using a credit card only.

Credit Card on File

A bank card on file is required to proceed with your surgery appointment and will be used for any credit or remaining balance on your account after the insurance company makes a payment.  Our office will make a reasonable attempt to notify you prior to crediting or charging your card on file but the office reserves the right to make such charges for services you received and agreed to be financially responsible for, regardless of whether you provide confirmation to our office’s attempts to contact you prior to making such charges.

No Show or Cancellation

You will be charged a cancellation fee of $250 for surgery appointments that are canceled or rescheduled within 3 business days of your surgery appointment.  To avoid a cancellation fee, please communicate any rescheduling needs 3 business days before the date of your surgery.