Financial Information

It is our goal at Northern Oral Surgery & Implant Center to provide you with the finest care at the most reasonable cost possible.

If you have dental insurance, we will submit a predetermination of benefits request to your insurance. If we have received a pretreatment estimate from your insurance provider, the patient responsibility will be due on the day of surgery. If we have not received a pretreatment estimate from your insurance provider, payment is expected in full. If payment in full is not possible, surgeries will be scheduled once a pretreatment estimate has been received from your insurance carrier. We will contact you when the pretreatment estimate has been received. We are only able to submit predeterminations to dental insurance. If only medical insurance is available, charges will be submitted after they have occurred (i.e. payment is due in full on day of service).

Payment Options:

1. Payment in full: We accept cash, check, Visa, MasterCard, American Express, and Discover. We also accept CareCredit (Lending Company). You can apply either by phone or online. You can use this service interest free for 6 months with no minimum financed, or 12 months with a minimum of $2,000 financed. You can apply online (www.CareCredit.com) or call 1-800-677-0718. Payments are made directly to CareCredit.
2. Insurance: If you have insurance and would like our office to submit charges to your insurance, we will be happy to do so as a courtesy to you; however we will need your correct insurance information on the day of the evaluation. If the cards are not presented or the information given is not complete or incorrect, we will assume you have no coverage.

If payment in full has been made, we will refund you if your insurance has made a payment on any of the services rendered.

If you have questions regarding your account, please contact us at 1-800-336-5495. Many times, a simple telephone call will clear any misunderstandings.

Please note: if there is any balance for services rendered this should be paid within 30 days. If the account goes over 30 days a 1.5% monthly finance charge (18% annual) will be applied. If your account goes over 60 days, it will be turned over to a collection agency and you are responsible for their charges.

Northern Oral Surgery & Implant Center

Financial Policy Specifics

We are committed to providing you with the best possible care. If you have dental or medical insurance, we will assist you in filing for those benefits. While the filing of insurance claims is a courtesy that we extend to you, we can only do so with a completed insurance form and insurance cards from you.

BASIC POLICY: Payment for services rendered is due in full at the time of service unless you have insurance. Our office accepts cash, personal checks, credit/debit cards (Visa, MasterCard, Discover, American Express) and CareCredit. There is a $35.00 returned check fee due and payable from you for each check payment returned to us by your bank.

FOR PATIENTS WITH INSURANCE: As a service to our patients, we will submit claims to your insurance carrier. To do this, we will need a copy of your insurance cards.We will submit a pre-determination to your insurance carrier and the amount due on the day of surgery will be determined by that estimate. If we have not received the pre-determination back from your insurance on the date of your scheduled surgery, we will ask that you pay the full balance and we will refund you as soon as your insurance company sends payment to us. Please understand that insurance is a contract between you and your insurance company. We must emphasize that, as dental care providers, our relationship is with you, not your insurance company.

MEDICARE PATIENTS: Medicare rarely pays for “dental” care.

MEDICAID PATIENTS: All patients must provide current eligibility identification information prior to being seen in order to determine coverage. Doral Dental (U-care) patients will need to contact Doral Dental (call the number on back of your card) and have them fax to us an authorization prior to making an appointment at our office.

NON-COVERED CHARGES: Any charges not covered by your insurance carrier will require payment in full at the time services are provided.

WORKERS COMPENSATION: If your injury is work-related, we require the necessary insurance billing information, claim number, case worker and employer authorization form prior to your treatment.

PERSONAL INJURY CASES: If your care is related to a personal injury, be sure to have the correct billing information at the time of your evaluation. Also, be sure to ask for an accident form to complete when you come to our office for the first time.

CANCELLATION OF APPOINTMENTS: Your appointment time has been reserved for you. We require at least 24 hours notice when canceling an appointment. This practice reserves the right to dismiss patients with excessive canceled appointments.

EXTENSIVE APPOINTMENTS: For our patients with longer appointment time blocks, payment will be due two weeks prior to the surgery day (as opposed to on the day of surgery). If one of these extensive appointments needs to be canceled, notification is due to our office at least 4 business days prior to the scheduled surgery date. If due notice is not given the office will charge a 10% fee for the missed or short-notice cancellations.