Patient Financial Policy

Dr. Zysset and Dr. Tylka provide the finest oral surgery care at the most reasonable cost to our patients. It is our goal to treat each of our patients with the highest caliber of care and respect.

Payments

All estimated payments and balances are due at time of check-in. Self-pay patients will be required to pay in full the day service is rendered. For your convenience, we accept Visa, MasterCard, American Express, Discover, Care Credit, cash and personal checks. We do not accept installments. A finance charge of 1.333% per month (16% annual) will be added to all past due accounts with balances over 90 days.

Insurance Claims

We are in network with Ameritas, BCBS (both medical & dental), Cigna Dental, Delta Dental, Principal and The Standard. Oral surgery procedures may be covered by dental and/or medical insurances, depending on your coverage. Please note we do not offer free consultations in this office. As a service to our patients, we will bill your primary and secondary insurance carrier (that we are in network with), provided proper paperwork is provided to us. This does not imply that your particular plan will cover your anticipated procedure, either in part or in full. Insurance is a contract between you and your insurance company. The ultimate responsibility for any unpaid balance rests with the guarantor/patient. Although we may provide an estimate of what your insurance may pay, we cannot be responsible for any discrepancy between what the insurance company quotes to us and what they actually pay. If the insurance company pays the policy holder directly, the policy holder must contact our office and is responsible for payment and agree to forward payment to us immediately.

Sedation

Some insurance companies will not pay for a patient to use sedation. If sedation is NOT allowed by your insurance company, you will be responsible for paying for the use of sedation in full.

Returned checks

The charge for a returned check is $35 payable by cash or credit card.

Outstanding balance policy

It is our policy that all past due accounts receive three statements. If payment is not made, we will make a final attempt to collect. If no resolution can be made, the account will be sent to a collection agency, along with possible discharge from the practice.

Assignment of insurance benefits

I hereby assign to Monte K. Zysset, DDS, FACS or Daniel J Tylka, DDS, MD the insurance benefits which are otherwise payable to me for their charges and direct that insurance payments be made directly to them. This assignment will remain in effect until revoked by me in writing. A photocopy of this assignment is to be considered as solid as an original. I understand that I am financially responsible for all charges whether or not paid by insurance. I hereby authorize assignee to release all information necessary to secure the payment.