Financial Information

WELCOME

Thank you for choosing Bridgeway Oral and Maxillofacial Surgery for your Oral Surgery care. We are committed to providing excellent care, and payment of your bill is part of successful treatment. Our financial policy is based on an open and honest discussion of fees. You may ask our staff for an estimate prior to seeing Dr. Doucet.

ARRANGEMENTS FOR PAYMENT IN FULL ARE DUE AT THE TIME OF SERVICE.

We accept Cash, Checks, Debit ATM Cards, Visa, MasterCard, Discover, and American Express. We also offer financing through Care Credit which, if qualified, has interest free financing for 6 months as well as low fixed rates over an extended period.

USUAL AND CUSTOMARY RATES AND MEDICARE FEE SCHEDULES

We are committed to providing excellent oral surgery treatment to all our patients. Our fees reflect our commitment to the quality our patients deserve and are considered usual and customary for the area, regardless of any insurance company’s determination. Exceeding the plan’s UCR fee or a Medicare based fee schedule does not mean that you have been overcharged for the procedure. The plan pays a set percentage of our fee or the plan administrators UCR and or Medicare based fee limit, whichever is less. These limits are the result of a contract between the plan purchaser and the insurance company.

OUTSIDE LABORATORY FEES

If pathological services are performed in our office, the use of an outside laboratory will be necessary. The pathological review and report will be billed to you separately from the laboratory. It is your responsibility to inform us if your insurance carrier/plan utilizes a specific outside laboratory. The fee range for pathological review by an outside laboratory is $190 – $800.

INSURANCE

As a service to our patients, we will bill your insurance company if you bring in all necessary insurance information, both dental and medical. Please be sure to disclose all dental and medical insurance information if you would like this service. Your insurance policy is a contract between you and your insurance company. As a health care provider, we are not party to that agreement. In the event we accept assignment of your insurance benefits, we require that pre-approved arrangements be made on the entire amount. Insurance policies vary and services provided may not be covered. Our office is committed to helping our patients maximize their benefits. We are currently not Medicare providers and as that patients that have Medicare do not bill them either.

MINORS

Payment for services of the treatment of minors is the responsibility of the adult accompanying that minor

MISSED APPOINTMENTS

Be advised that the policy of this office is to charge for missed appointments. Cancellation 48 hours or less prior to a scheduled surgery appointment date is subject to a cancellation fee up to $500 regardless of actual damages or reasons for cancellation. Cancellation 24 hours or less prior to all other non-surgical appointments (except post-operative appointments) are subject to a cancellation fee of $100 regardless of actual damages and reasons for cancellation. We may require a deposit to reserve a place in our surgery schedule.

SERVICE CHARGES

The policy of this office is to charge a $20.00 rebilling fee on all accounts that are over 30 days past due. We will charge $40.00 for returned checks.

COLLECTION FEES

Fees incurred to collect payment will be billed to, and are payable by the patient/responsible party.

FINANCIAL CONSENT

The patient (or Guardian) agreed to be fully responsible for the total payments of treatment performed in this office.