Financial Information for Kingsway Oral & Maxillofacial Surgery

We make every effort to keep down the cost of your oral surgical care. For your convenience, we accept Visa, MasterCard, America Express, Debit, and cash. We deliver the finest care at the most reasonable cost to our patients; therefore, payment is due at the time service is rendered. Other arrangements can be made with our Manager/Accounting team, depending upon special circumstances. If you have any dental and/or medical insurance, we will gladly complete these forms for you and send a pre-determination so you will know your coverage and reimbursement level. Please note, your health insurance plan is a contract between you and the company providing benefits.  

Please remember that insurance is considered a method of reimbursing the patient for fees paid to the doctor and is not a substitute for payment. Some companies pay fixed allowances for certain procedures and others pay a percentage of the charge. The particular plan that you have is a contract between you and the company providing benefits. It is the patients or guardians responsibility to pay any deductible amount, co-insurance or any other balance not covered by your insurance company.

If you have received written pre-authorization from your insurance company prior to your surgery date, we request payment of the balance not covered by your insurance on the day of surgery. NOTE: If we do not receive payment from the insurance company within 30 days after surgery, you will be billed directly. Overdue balances will be sent to collections after 90 days.

Your general anesthetic will be administered and monitored by a fellowship certified medical anesthesiologist. The anesthetic fees will be collected on day of surgery in full. Our office will provide you with a separate form indicating the medical anesthesiologist charges, codes, and a list of medication used. You may send this form directly to your insurance carrier to see if any reimbursement is possible.

Should you have any questions about your dental treatment, fees or payment arrangements, please do not hesitate to contact us.

It is important to remember that you are fully responsible for all fees charged by this office regardless of your level of insurance coverage.

Your signature on your file is your authorization for the release of information to process your claim. As well, your signature on a financial itemization is your acknowledgment of your financial responsibility for all charges.