Financial Information
Thank you for choosing Dr. Jeff Kenney, D.D.S. Oral & Maxillofacial Surgery. This document outlines our billing process and the payment options available in this office.
Payment Options:
• Cash/Check/Money Order
• Credit Cards (Visa, MasterCard, Discover & American Express)
• Care Credit
Payment is required prior to treatment. If you choose to discontinue care before treatment is complete, you will receive a refund LESS the cost of care/treatment already received. Refunds will be issued to the patient/guarantor responsible for the account.
For patients with insurance, we will work with the insurance carrier to obtain information regarding benefits. Our billing office will bill your insurance company directly for reimbursement for treatment. You (the patient or the responsible party thereto) will be given an ESTIMATE of charges which will include what we ESTIMATE the coverage will be. Please note: THIS IS AN ESTIMATE ONLY. We provide this estimate as a courtesy and suggest you contact your insurance carrier to inquire about your specific benefits. Our estimates are based on information we obtain regarding benefits from your insurance carrier and are not guaranteed for payment. You are ultimately responsible for any costs not covered by your insurance. If we have not received payment within 90 days after billing the insurance, we reserve the right to bill you (the patient or the responsible party thereto).
INSURANCE WAIVER
Your insurance may not pay for items or services listed below. Insurance pays for services based on minimal plan provisions and may not
cover services that are reasonable and necessary for your health.
• CBCT
• Sedation
• Nitrous Oxide
• IV Drugs for Nausea, Infection, Swelling
• IV Supplies
• Bone Grafting
• Dental Implants
The total charge for these non-covered services will be added to the estimate of charges provided to you.
NOTICE OF NON-COVERED SERVICES:
Insurance carriers will only pay for services that are covered by your particular plan. You are responsible for any balance on your account, including balances resulting from insurance misquotes, excluded services, waived items, and non-covered services. Your treatment plan may contain a recommendation(s) and/or you may require a procedure(s) that is not a covered benefit with your insurance carrier. You (the patient or guarantor) are fully responsible for any and all charges denied by your insurance company for services rendered. Your treatment plan may require and/or you may opt for a procedure that is not a covered benefit with your insurance carrier. You (the patient or guarantor) are fully responsible for all charges denied by your insurance company for all services rendered.