Financial Information

FINANCIAL POLICY (signature required on Patient Registration form)

We, The Center for Oral & Maxillofacial Surgery & Implantology, thank you for choosing us as your Oral and Maxillofacial Surgeon. We consider it a privilege to serve your needs and we look forward to doing so. We are committed to providing you with the highest quality care and building a successful provider-patient relationship with you and your family. We believe your understanding of our patients’ financial responsibility is vital to that provider-patient relationship and our goal is to not only inform you of the provisional aspects of that financial policy but also to keep the lines of communication open regarding them. If at any time you have any questions or concerns regarding our fees, policies, or responsibilities; please feel free to contact Melissa (office manager) at The Center for Oral & Maxillofacial Surgery and Implantology Phone Number 973-667-5844. We believe this level of communication and cooperation will allow us to continue to provide quality service to all of our valued patients.

We accept payments for your convenience such as (cash, check, or credit card). A $35.00 service fee will be charged for all returned checks. Additionally, you may authorize us to keep your credit card on file for your convenience knowing that we adhere to the highest level of information security. We realize that temporary financial problems may affect timely payment of your account. If this should occur please contact us for assistance in the management of your account. Our goal is to provide quality care and service. Please let us know immediately if you require any assistance or clarification from anyone within our business.

Insurance Please remember that your insurance is a contract between you and your insurance carrier. We will, as a courtesy, bill your insurance and help you receive the maximum allowable benefit under your policy. We have found that patients who are involved with their claims process are more successful at receiving prompt and accurate payment services from the insurance carrier. It is your responsibility to provide all necessary insurance eligibility, identification, authorization, and referral information and to notify our office of any information changes when they occur. It is the patient’s responsibility to know if our office is participating or non-participating with their insurance plan. Failure to provide all required information may necessitate patient payment for all charges. When insurance is involved, we are contractually obligated to collect co-payments, co-insurance, and deductibles, as outlined by your insurance carrier.

Miscellaneous Forms, Additional Information and Authorizations We will provide all necessary information to have your benefits released. However if it becomes necessary to submit redundant or unnecessary information for the completion of the claim forms for school, sports, or extra curricular activities; there will be an administrative fee, not to exceed $35.00, for the additional information. Missed

Appointments We require notice of cancellations 24 hours in advance. If you fail to keep your appointments without notifying us in advance: a missed appointment fee will apply. These fees are typically $35.00 but not to exceed one-half of the cost of your scheduled appointment.

Fill out our Appointment Form or call us at The Center for Oral & Maxillofacial Surgery and Implantology Phone Number 973-667-5844 if you have any questions or to schedule an appointment with Dr. Echo today!