Financial Policy

It is our pleasure to serve your oral surgical needs. We strive to make this experience as stress free as possible. By providing our financial policy we are able to maintain good communication with our patients. If you have any questions, do not hesitate to ask our Financial / Insurance Specialist(s).

PAYMENT:

  • Payment is due when the services are rendered unless other arrangements have been made.
  • A copy of your driver’s license or government issued identification card is required.
  • We accept cash, personal checks, Visa, MasterCard, Discover, or American Express credit cards.
  • We also accept CareCredit, a healthcare credit card, which, upon approval, has various financing options available to meet your needs, including, in some cases, interest free, if your card is paid in-full within 6-12 months. You can apply online (www.CareCredit.com) or call 1-800-365-8295. Payments are made directly to CareCredit.
  • If the cost of your treatment changes or if your insurance does not cover their full estimated portion for ANY reason, you shall be notified that your remaining balance will be charged to your credit/debit card on file.

CANCELLATIONS / MISSED APPOINTMENT:

  • A $100.00 deposit shall be required to reserve your surgery appointment. This deposit shall be applied to your surgery; however, if your surgical appointment is not cancelled at least 24 hours in advance or your surgical appointment is missed, the deposit is non-refundable.

RETURNED CHECKS / STOP PAYMENT:

  • Returned checks shall incur a $30.00 service charge.
  • Stop payment is a breach of payment and is subject to the $30 service fee, legal and/or other expenses involved in collecting the payment.

COPYING / TRANSFERRING OF RECORDS:

A copy of your healthcare records is available for the following fee:

  • $25 for the first 20 pages; then $0.50 per page for every copy thereafter.
  • $15 per copy of x-ray.
  • Actual cost of mailing or shipping.
  • A fee for executing an affidavit, not to exceed $15.00.

DIVORCED PARENTS OF PATIENTS:

The adult who signs a minor child into KOS on the day of service acknowledges and accepts responsibility for payment. This office does not promise to send bills or records to the other, custodial or non-custodial, parent/guardian for issues of payment or communication. Parents are responsible between themselves to communicate with each other about the treatment and payment issues. We do not get involved in custody issues.

REFUND(S):

  • Patient refund(s) will not be processed until all the insurance processing is finalized.
  • Overpayment(s) will be refunded to the appropriate party within 30 days.
  • Refund(s) less than $5.00 will be issued upon request only.

MORE INFORMATION:

Communication can prevent many misunderstandings. Most issues can be settled quickly and easily. If you require financial assistance, please discuss the situation with our Financial / Insurance Specialist(s). We will strive to come to a satisfactory arrangement. Please call if you have a question about your bill. Please call (281) 358-2002.