Patient Information
Oral Surgery Financial Policy
Payment is due at the time of service if patient has no insurance. For patients with insurance, their estimated portion is due at the time of service
We accept Visa, MasterCard, Discover and debit cards, as well as Care Credit and Springstone Financial.
We offer a 5% discount for patients paying their treatment plan in full at the time of service with cash or check only.
We offer a 10% Senior Citizen discount for patients 62 or older. This discount cannot be combined with any other discounts.
We will be glad to bill your insurance for you. This is a courtesy and not a requirement. We will bill up to two insurance companies.
Insurance companies use the term “usual and customary” when setting fee limitations on services. The term suggests but does not necessarily reflect, the average fees charged by doctors in our area. Please be aware that some insurance companies pay claims based on their fee schedules and not those of our office. You will be responsible for any difference due to usual and customary, fee schedules, deductibles or maximum benefits met.
We are not a participating or preferred provider for any insurance company. We are considered an out of network provider. Therefore, your out of pocket expense could be greater.
We are not Medicare providers and do not accept OHP, COIHS, or Tricare insurance.
We require preauthorization for all Hospital surgeries TMJ splints and Sleep Apnea Appliances. A minimum 50% deposit is required at the preoperative appointment, regardless of insurance coverage, for all hospital surgeries. Hospital, Lab and anesthesiologist charges are separate from our office.
If any balance is due and owing is not paid within thirty (30) days from the date of the invoice, patients will be charged interest at a rate of 18% per annum. If this agreement of any invoice is placed in the hands of an attorney for collections, the patient promises and agrees to pay to Keith E. Krueger, DMD, PC its reasonable attorney fees and collection costs even if no suit or action is filed. If suit or action is filed, patient agrees to pay Keith E Krueger, DMD, PC any and all such reasonable attorney fees as shall be affixed by an arbitrator or courts in which this suit or action, including any appeals, are arbitrated, hear or decided.
Signing this form is acknowledgement that you understand and accept our financial policy.
There will be a 25.00 $ fee for all returned checks.
Financial Policy Form
This form, Financial Policy, presents the information that federal law requires us to give our patients regarding our privacy practices.
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