Our Insurance department exists as a courtesy and convenience for you. The relationship is between you, the insured patient, and your insurance company. Any questions about insurance should be discussed with them. Our office will make every effort to determine the extent of your insurance coverage and to provide appropriate information so as to maximize your benefits. The insurance company may give us an indication of that coverage.
It may be necessary for you to make a payment on the day of the procedure. These monies will be applied to the patient co-payment / co-insurance required by your insurance company. This payment is only an estimate of benefits and may need to be adjusted once final payment is determined by your insurance company. If there is a balance owed on the account, you will be billed at that time.
The insurance companies are required to respond to a claim within thirty days. When there are overlapping coverage’s, response time may be increased. Timing of the insurance payment is out of our control. Our office makes every attempt to control increases in medical costs. To that end, our accountants state that we must have payment for services rendered within eight weeks. Therefore, if your insurance company has not made payment for your care within eight weeks, we must bill you for the service. To avoid this, we would advise that you contact your insurance carrier if you have not been notified of payment by six weeks after your visit.
Once your appointment is made, our office reserves that time for you. If you must cancel your appointment, we require (24) twenty-four hour notice so that we may have an opportunity to give that time to another patient. Any appointment cancelled without at least twenty-four (24) hours notice prior to your scheduled time will be subject to a $50.00 fee. This fee is not covered by any insurance company and would be an out of pocket expense to you.
ALL PROFESSIONAL SERVICES RENDERED ARE CHARGED TO THE PATIENT. Necessary forms will be completed to expedite insurance carrier payments after payment is received from the patient. Co-payment is requested at the time of the visit. We do not participate with Medical Assistance. We can not submit claims to any Medical Assistance Programs because of our non-participation. You will be responsible for all charges if you have Medical Assistance.
THE PATIENT IS RESPONSIBLE FOR FEES, REGARDLESS OF INSURANCE COVERAGE. It is customary to pay for services when rendered unless other arrangements have been made in advance. AUTHORIZATION TO PAY BENEFITS TO THE ORAL SURGEON: I hereby certify the above named services were rendered and direct payment may be made to the Oral Surgeon named hereon. I am financially responsible for charges not covered by my insurance. I request that payment of authorized benefits be made to Snyder & Dugan Oral and Maxillofacial Surgery for any services furnished to me by physician or supplier. I authorize any holder of medical information about me to release to the Health Care Financing Administration and its agents, needed to determine these benefits payable for related services.
Due to privacy rules, Snyder & Dugan Oral and Maxillofacial Surgery is restricted in how we can communicate with you. Unless we receive authorization from you, we are prohibited from discussing your medical care or billing matters with your spouse, adult children, power of attorney or other individuals. Please indicate here your preferred method of contact, and list the individuals with whom we are permitted to discuss information.
The United States government has passed a law that requires us to clearly identify guidelines for release of medical information. This law took effect on April 14, 2003. The purpose of this law is to safeguard medical information from sources not authorized to posses this information and at the same time to release appropriate information to other healthcare providers, insurance companies and other authorized agencies.
You have the right to request restrictions on the use and disclosure of your health information. You also have the right to inspect and / or copy your health information. We may charge you a reasonable charge to cover copying, etc. It is our goal and requirement that we use your medical information with confidentiality and our best judgment in any communication with your family and others.
An expanded document is available upon request, which covers these issues in greater detail. If you would like a copy of this document, please let our office staff know and we will be happy to provide it to you.
Dugan & Sweeney Oral and Maxillofacial Surgery is in compliance with the Red Flag Rule, which became effective August of 2009. A copy of the policies and procedures is available upon request. If you would like a copy of the document, please let our office staff know and it will be provided to you.
Dugan & Sweeney Oral and Maxillofacial Surgery