You are financially responsible for all charges regardless of potential insurance coverage. We may submit an insurance claim as a courtesy to our patients with insurance. We ask that you pay, on the day of treatment, the portion we estimate will not be covered by your insurance company(s). Payment plans are not available on this amount. Please remember that we can only estimate the amount to be paid by an insurance company. It is the responsibility of the patient, not the provider, to know what is covered or excluded from his/her plan. As out of network providers with most insurance companies, we do not take any provider discounts or write-offs. If your insurance company has not paid off the account balance within 60 days, we will ask you to pay the remaining balance in full. If we are unable to verify insurance benefits with the insurance company, the account will be considered private pay and the payment requirements listed below will be applicable. You hereby assign, transfer and set over to A.O.M.S. all of your rights, title, and interest to your reimbursement benefits under my insurance policy for services provided by A.O.M.S.
Accounts for which we are not submitting a claim to an insurance company will be considered private pay. We ask that you pay your charges in full on the day of treatment. For accounts in good standing a payment in full discount of 5% for cash or check may be applied. Payment plans may be available through an outside lender. If you choose to apply for this payment program, you are agreeing to have your credit report run. Please speak with our Financial Coordinator for more information on this program.
Past Due Accounts, Collections
Any accounts with charges that remain unpaid for 90 days from the last date of service will be treated as delinquent or ‘past due”. Past due accounts are subject to interest as explained below and are considered closed without further notice. We reserve the right to decline to provide any further services until the closed account is paid in full or appropriate payment arrangements are made. Past due accounts may subsequently be reviewed for assignment to an outside agency for collection. In the event that legal action is taken to collect any amounts owed, the prevailing party shall be entitled to recover their reasonable attorney fees.
Exam & X-Ray Fees
Patients are responsible for exam and/or x-ray fees if treatment is not completed in the same appointment. However, as a courtesy for patient accounts in good standing, the exam fee may be reversed on the day of surgery if treatment is completed within 90 days.
As of July 1, 2004, the oral surgeons at A.O.M.S. have opted-out as Medicare providers. Should you choose not to go to a Medicare Part B participating provider and to have services performed by one of our providers, you are required to sign a “Contract for Services to a Medicare Part B Beneficiary” agreeing to private payment for services and agreeing that Medicare will not be billed by either the patient or the provider.
We reserve the right to apply overpayments from one account to a remaining balance on another account with the same guarantor.
According to Oregon law, a spouse is financially responsible for family expenses incurred by the other spouse or for the benefit of their minor children or stepchildren. It is agreed that all charges incurred or fees imposed according to this agreement are family expenses for which both spouses/parents are financially responsible.
You agree, in order to service your account or to collect any amounts you may owe, we may contact you by telephone at any telephone number associated with your account, including wireless telephone numbers, which could result in charges to you. We may also contact you by sending emails, using any email address you provide to us. Methods of contact may include using pre-recorded/artificial voice messages and/or use of automatic dialing. Your consent to these communications applies to those communications initiated by our office or by any agent, attorney, or collection agency acting on our behalf.
To the extent permitted by law, we reserve the right to apply a finance charge in the amount of 1.5% per month or 18% annually to all account balances after 90 days from the last date of service until paid in full. A fee of $35.00 will be assessed to your account for any check returned unpaid by your bank and any payment in full discounts will be reversed.
We accept personal checks, money orders, cash and major credit cards.