Apex Oral Surgery’s Office and Financial Policies.

**This Office and Financial Agreement ("Agreement") is made effective as of the date of the patient’s signature and/or date of service, between “You” [also known as “ the patient”  (or legal guardian)  and “account holder”), and Apex Oral Surgery  ("The Establishment").**

  1. Responsibility for Payment: 

    1. The Patient (or their legal guardian and account holder) acknowledges and agrees that they are fully responsible for fulfilling the financial obligations related to their healthcare services at the establishment, and as contracted with their insurance carrier, or lack thereof. 

    2. There is a 2.5% transaction fee for all payments completed via debit, credit, on-line payment, and Venmo.

  2. Insurance Obligations

    1. The Patient understands that it is not the Establishment's responsibility to determine if we are in network with your insurance carrier(s).  Please see our list of network participation on our website for guidance. You may also call your insurance customer service number and provide them with our Tax ID # to determine if we are in network and participate with your plan.

    2. The Patient understands that it is not the Establishment's responsibility to fulfill the obligations and payments of the Patient’s  insurance carrier. The Establishment's role is limited to providing necessary services  and in accordance with the patient's insurance contractually negotiated fees ( ie submitting complete and accurate claims). The Establishment is not responsible or obligated to pursue any money from your insurance to ensure your account is paid in full. 

    3. If you do not have insurance, or do not have an insurance we participate with,  you are considered out of network, and  are responsible for the full cost of treatment, as determined by our regular office fee schedule and us expected to be paid in full at the time of any services rendered. As a courtesy, claims to out-of-network insurance carriers can be generated for you at your request, to see if you are entitled to any out of network benefits. 

  3. Payment Terms

    1. Payment of the contracted rate as set forth by the patient's insurance provider is mandatory, or by our regular office fees for those patients out of network. The Patient agrees to make full payment within 60 days from the date of the service or invoice.

    2. If after your claim is processed completely, you believe that your insurance should be providing a larger contribution towards your services/bill, you must get in contact with your insurance carrier(s). This is a matter that needs to be handled by you and your insurance carrier. Please note that the amount your insurance decides to pay are decisions made exclusively by your insurance carrier, and are not within our office's control. As a result, you are still required to settle the balance of the contracted amount owed to us. You are welcome to engage with your insurance company regarding reimbursement after payment has been made in full. Your credit card on file will be used to pay for any remaining balances after 60 days. Additionally, please be aware that failure to pay in-full within the 60-day grace period may result in your account being referred to a collections attorney (see section 4).

  4.    Penalties, Collections, and Legal Action 

    1. If the Patient fails to make full payment of the contracted rate within the specified 60-day period, their account will be subject to an interest rate fee of 1.25% per month [15% per year] of all balances until the account is settled in full. 

    2. Insufficient Funds with Checks (Returned/”bounced” checks): A $35 fee will be applied for any returned  or bounced checks.

    3. Additionally, accounts with a balance over 60 days are eligible to be turned over to our collections attorney. In the event of an account being turned over to a collections attorney,  the patient understands that they may be subject to legal jurisdiction, which could result in

      1. Damage to their credit scores

      2. Financial liens on their assets

      3. A collections and attorney fee of $350 to cover the cost of legal services.

  5. Appointment Policies: 

    1. Initial Consultations and Visits:

      1. Initial consultations/exams/visits and X-Rays are not complementary services. They are a billable service, and these services may not be covered 100% by any insurance options available to you. This means there could be an out-of-pocket expense at the conclusion of your initial visit.

      2. You must be prepared for your initial visit by presenting with a proper referral from your dentist, any relevant x-rays, and with your patient intake form complete. Otherwise, your visit may be rescheduled or canceled.

    2. Missed Appointments and Late Cancellations/Rescheduling Fees: A Missed Appointment (or Late Cancellation) is defined as either; not appearing for an appointment at all, arriving more than 20 minutes late for an appointment, or not formally cancelling the appointment [by phone or via the cancellation form] within 24 hours of their scheduled appointment. If a patient arrives 20 minutes or later for their scheduled appointment, the visit will need to be rescheduled, will be considered a missed appointment, and subject to a missed appointment fee (see below).

      1. A $75 fee will be charged missed appointments and late cancellations for initial consults, office visits, or re-evaluations.

      2. The fee for any missed surgery appointments or those not canceled within 24 hours of the surgery appointment time is $500. This $500  fee is irrespective of any estimated costs of the surgery, even if that estimate cost of surgery happens to be lower than the missed/late fee itself.

      3. Fees for missed appointments and late cancellations/rescheduled visits will not be submitted for insurance reimbursement as they do not recognize them as insurable service by any insurance carriers. Thus, the patient (or guardian) is solely responsible for the cost of any and all missed visit fees.

  6. Patients will be required to review, agree to, and sign our office and financial Agreement in order to receive any treatments or services at the establishment.

  7. Patients will be required to review, agree to, and sign our  HIPAA and Privacy Policy Agreement in order to receive any treatments or services at the establishment.

  8. Governing Law

    1. This Agreement shall be governed by and construed in accordance with the laws of the state in which the Establishment operates. 

    2. **Apex Oral Surgery Reserves the Right to Amend This Agreement as Necessary**