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Prior to your scheduled surgical procedure our office will provide a financial worksheet which outlines the estimated cost of the surgical procedure for the surgeon*, your insurance discount and financial responsibility, and what your insurance company is estimated to pay on your behalf.

This worksheet and a minimum of 50% of your financial responsibility is due at least one week prior to the date of the surgical procedure. Payments are accepted in office or online on our Payment Page. The remaining balance is due upon adjudication by your insurance company. There is a $200 charge that will be applied to your account in the event that you do not present for your surgical procedure. This charge will be deducted from any refund due as a result of the cancelled surgical procedure.

If you have any questions regarding your insurance coverage or your financial responsibility, which is assigned by your coverage, please contact your insurance company. We recommend that you have your insurance card handy when you speak with them.

*The estimate is for the surgeon only. You may receive bills from the surgery center/hospital (facility) and other health care providers. Please note that this financial agreement outlines our best estimate for what will be performed, however, additional or different procedures may be necessary to complete the treatment. We follow the national coding guidelines as issued by the American Medical Association. The estimate includes customary post-operative care in our office as provided by your coverage.

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