The primary goal of our physicians is the provision of quality patient care. This goal can be accomplished through sound fiscal management, the practice of keeping costs contained, and having the cooperation of our patients implementing the following policies.
Please review this document thoroughly and sign below. This will become part of your file.
Our goal is to provide quality medical care and in order to do that, we had to implement a cancellation policy. The policy enables us to better utilize available appointments for our patients. When scheduling an appointment credit or debit card information must be available. Please call our office immediately if you find you cannot keep your appointment. Cancellations of scheduled appointments must be communicated to our office at least 24 hours prior to the scheduled appointment time. For your convenience you may leave a message of cancellation on our voice mail system. Monday appointments must be cancelled by noon of the preceding Friday.
In the event that appointments are not cancelled with 24-hour notice, patients will pay a $35 deposit at the time of scheduling for future appointments with our aesthetician and Nurse Practitioner.
Our massage therapist requires a deposit of $50 that is due at the time of scheduling. Any appointment not cancelled with a 24-hour notice will forfeit their deposit.
Appointments not cancelled with a 24-hour notice for the physician will forfeit their $100 consultation fee that was collected at the time of scheduling.
THESE CHARGES ARE EXCLUSIVELY YOUR RESPONSIBILITY.
COSMETIC SURGERY – Cosmetic procedures require a 20% non-refundable deposit at the time the surgery is scheduled. 2-3 days prior to the surgery date, the remainder of the physician’s fee is required to be paid in full.
This is only payable in the form of cash, cashier’s check, major credit cards or money order within a week of surgery.
COSMETIC SURGERY CANCELLATIONS – Surgery scheduling requires careful planning and coordination between our office, the surgery center and their operating room staff, as well as the anesthesiologist, if applicable. Therefore, please understand the importance of respecting our 48-hour cancellation policy. Surgeries cancelled more than 48-hours prior to the surgery date that are rescheduled within 5 business days will be allowed to apply the 20% non-refundable deposit towards the new surgery date. Surgeries cancelled less than 48 hours in advance will forfeit the deposit. If there is a balance over the non-refundable deposit amount you will need to request a refund within 1 year of cancelling the surgery. After 1 year has passed the balance will be forfeited.
ASSISTANT SURGEON FEES – Your physician may elect to use the services of an assistant surgeon. Although his fee will appear on your monthly statement, you will not be responsible for payment of this fee. This will be billed to your insurance carrier, and assignment accepted.
INSURANCE CLAIMS – The benefits paid by insurance companies for plastic surgery vary greatly from carrier to carrier and plan to plan. Therefore, we make every effort to determine in advance if insurance coverage exists. We will obtain your benefit information such as deductibles, coinsurance and out of pocket expenses. This will determine the amount, if applicable, that will be required to be collected prior to scheduling your procedure. We do this because we believe you need to be as informed as possible before surgery. We know you realize that you are ultimately responsible for the full payment of your account, but we have found that our knowledge and experience can be an important factor in assisting you to collect your maximum benefits.
PATIENT ACCOUNT BALANCES – You will receive monthly statements showing the patient balance and insurance balance, if any. Payments are required monthly on any patient balance. If you are unable to pay your bill in full, we will be happy to arrange a comfortable monthly payment plan with you.
PRODUCT GIVEAWAY RECEIPEINTS – If you are the winner of a product due to a giveaway hosted by our office you will have 6 months from the date of notification or the office’s receipt of product to pick up the product as they have expiration dates. Thank you for your understanding.
The Plastic Surgery Center LLC strives to provide excellent health care. We will only release information concerning you to those that are necessary and/or if we have your permission. Thank you for choosing our practice to provide you medical care. Please feel free to inquire about anything we can assist you with.
Please sign that you have read and agree to our Business Policy as stated above.