Financial Policy & Facts About Insurance

  1. Your insurance is a contract between you, your employer, and the insurance company. We are not a party to the contract. We will work with all insurance companies; however, some of the companies will only reimburse doctors who have agreed to accept their fees in order to attract more patients. We will do our best to assist you with your insurance information; however, the ultimate responsibility of understanding your reimbursement policies lies with the patient.
  2. As a courtesy to our patients, we will submit and facilitate insurance claims; however, it is common for insurance companies to delay payment, and payment is ultimately the responsibility of the patient. Final payment is due no later than sixty days past treatment regardless of insurance status.
  3. It has been the experience of many doctors that some insurance companies tell their customers that “fees are above the usual and customary” rather than saying, “Our benefits are low.” Utah Facial & Oral Surgery is committed to offering exceptional care with fees that are comparable in the region.
  4. Unfortunately, insurance benefits will almost always be less than anticipated. These benefits are negotiated by your employer and insurance company. For your convenience, we will ESTIMATE what your insurance will cover. This is JUST AN ESTIMATE. Your insurance co. will determine your benefit. This ESTIMATE will be due at the time of service.

In consideration of treatment by the doctor, the undersigned agrees:

  1. To pay the amount charged for all treatment and services to the undersigned, his/her family, or the patient.
  2. That if payments are extended beyond 60 days from the date of first billing, to pay 1.5% per month on the unpaid balance. (Annual percentage Rate of 18%. Minimum monthly charge of $2.00)
  3. In the event any amount(s) is/are referred to a third party debt collection agency, I agree that in addition to any other amount(s) allowed for by law, (such as interest, court costs, reasonable attorney’s fees, etc.) I will also be responsible for a collection fee up to 40% of the principal amount(s) owing as allowed by Utah Code Annotated, sec. 12-1-11. The terms of this paragraph shall apply to all amount(s) incurred by me or by any individual for whom I have a legal responsibility whether such amount(s) are incurred today or after today.

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