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Thank you for choosing
Prairie Oral Surgery as your health care provider. We are grateful
that you are entrusting your care to us. Please understand that
payment of your bill is considered part of your treatment
experience. The following is a statement of our Financial Policy
that you will be asked to review and sign before receiving services in our
clinic.
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Click on
this link to download an Adobe Acrobat version of our Financial
Policy
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Attention!
Before viewing the form you will need Adobe Acrobat Read to view
and print these forms. |
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Informational Links About Financing |
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- You Are
Responsible for Your Bill
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Payment for Our Services is Due on the Day You Receive
Services
- If You Have Insurance
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We Will Collect the Estimated Amount You Will Owe at Your
Appointment
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The Dental Fee Plan & Citi Health Card Financing Plans
- Questions?
Please Ask Our Staff
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You Are Responsible for Your
Bill |
| As the recipient of our
services, you are responsible for the charges associated with each of the
services you received during the course of your treatment. You (or
your guardian, if you are a minor), must pay for the services you receive
from our office. You may have insurance, financial support
from family members, or non-resident persons who may pay all or a portion
of your bill on your behalf, but you remain legally responsible for your
bill. |
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Payment for Our Services is
Due on the Day You Receive Services |
| Payment for our services
is due on the day you receive the services. If you have no
insurance, the entire amount of your bill will be due on the day of your
appointment. If this amount is difficult for you to pay out of
pocket on the day of your appointment, we have several financing plans
available to you outside of our practice. We are unable to finance
your treatment through our office. Our office provides medical
services, banks provide financing services. You cannot pay your bill
“over time” or “on account” through our office. We would be happy to
help you obtain financing for our services before treatment is rendered
through several financing companies we work with. |
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If You Have
Insurance |
| If you
have dental or medical insurance, we will assist you in
receiving the maximum allowable benefits available under your
insurance policies. We will file a claim for services on
your behalf, and in many cases we can receive some payment
directly from your insurance company. However, you remain
responsible for your bill, not your insurance company. If,
after a reasonable amount of time, we are unable to receive
payment for services on your behalf after following normal claim
submission procedures, we will expect payment in full from you. |
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We Will Collect the Estimated
Amount You Will Owe at Your Appointment |
| Depending on your
insurance, we will collect on the day of your appointment the amount
estimated to be your responsibility. We determine this amount by
estimating the services and charges we think you may receive and then
subtract the amount we believe your insurance company may pay on your
behalf (based on the insurance information you give us). We then ask you
pay the remainder on the day you receive services. You may require
additional services (or fewer services), in which case your charges may be
greater or less than our estimate. Please keep in mind that this is
only an estimate and we cannot pre-determine the exact services you will
require or guarantee the final payment amount from your insurance
companies. |
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The Dental Fee
Plan & Citi
Health Card Financing Plans |
| As we require payment for
services on the day you receive them, we have made arrangements with two excellent financial service
companies called the Dental Fee Plan and the Citi Health Card to provide
financing options for you to pay for services over a number of future
months. These financing services can offer low-interest, or in some
cases, zero-interest options for paying for your dental services... You may apply over the
Internet, by telephone, or my mail for financing. If you apply over
the Internet or by telephone, you will receive immediate notification of
your acceptance. To visit their web sites on the Internet, click on
the logo below, or simply call our office for more information. |
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Questions? Please Ask Our
Staff |
| Our staff is trained to
answer your questions regarding your bill and payment arrangements.
We do our best to stay on top of insurance plans and would be happy to
help you try to understand all of the confusing details and provisions
found in many insurance plans. We don’t mind talking about money and
bills, so please, feel comfortable discussing our charges and your
bill. |
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