We are honored to take care of you. Our #1 goal is happy patients with great results. The whole team is excited to support you in every way we can. To help with your financial planning for surgery, please be advised that the payment policy is as follows:
Scheduling Fee:
Acceptable forms of payment include: Cash, Check, Credit Card, Discover, Visa, MasterCard, Wire Transfer, *Cherry, *Care Credit, *Alphaeon Credit.
Consultation fee is valid and applicable toward your surgical balance for 14 days from your consultation date. Consultation fee will be billed for providers time if the appointment is not canceled or rescheduled at least 48 hours in advance. To avoid this charge, please notify our office within the required timeframe. Your surgical deposit must be collected within 14 days in order for the consultation fee to be applicable toward the surgical balance. A non-refundable scheduling fee equal to 10% of your quote is required to schedule surgery or a procedure. If you cancel or reschedule your date for any reason, the scheduling fee is not refundable. Please be certain when booking your date as there are no exceptions. If you are on the move up list because an earlier date was not available, the deposit will apply if your procedure is moved to an earlier date. Financing programs may not be applied towards the scheduling fee. Scheduling fee must be paid with cash, check, or credit card. Payment for surgery is due in full four weeks prior to your procedure date.
Cancellation/Rescheduling Policy:
Surgery scheduling requires careful coordination and planning with the clinic, OR, and anesthesia staff. Additional preparation includes ordering case-specific supplies, sterilizing instruments, ordering and reviewing medical tests (i.e., blood work, mammograms, EKG's, medical clearances) ordering prescriptions, and providing pre-op education.
If you should cancel/reschedule prior to your procedure, fees include your non-refundable 10% scheduling fee in addition to: 17-21 business days: 25% loss of total surgical quote; 11-16 business days: 50% loss of total surgical quote; 6-10 business days: 75% loss of total surgical quote; 5 business days or less: 100% loss of total surgical quote.
Your safety is always our priority. If you need to cancel surgery due to an illness, please contact our office immediately. With proper documentation from your physician your deposit may be transferred to the next available surgery date once you are medically cleared.
If required, you are responsible for obtaining medical clearances from your doctors.
Cancellations due to an inability to obtain medical clearance or lab results will adhere to the above cancellation/ rescheduling policy.
Cancellations due to medical information being withheld/omitted (i.e., medications taken, existing medical condition, surgeries performed) will adhere to the above policy.
You are responsible for arriving on time for your surgery. Tardiness adversely affects other patients’ surgeries and the surgery center. Please be ready to arrive earlier than scheduled if requested. Surgeries often are ahead of schedule. You must be available if contacted. Arriving late for a surgery will result in a $500 fee and may result in your surgery being delayed or rescheduled.
All appointments require 48 business hour notice to reschedule. Appointments rescheduled with less than 48-hours are subject to a $100 charge for not providing proper notification regarding schedule changes.
Additional Services Beyond Quote:
Prior to surgery, any changes or additions to your quote must be made and updated through your Patient Care Coordinator. If for any reason you receive additional services outside of your quote the day of surgery, it will be updated and billed 48 hours after your surgery. We do not complete any legal forms, FMLA, short term/long term disability forms or related letters. There will be a $150 minimum fee for completing forms (if completed at the discretion of the provider). Any complimentary services offered are at providers discretion.
Implants:
Your implants are chosen at your consultation. A complimentary 3D scan will be created as an additional resource to translate and manage clinical expectations pertaining to surgical results; 3D scans/imaging do not serve as a guarantee for postoperative results. Each scan is created by the doctor with your specific anatomy and goals in mind. In-person consultations are provided the opportunity to try on implant sizers and will receive one complimentary 3D scan. Virtual consultations are provided two complimentary 3D scans, and will have the opportunity to try on implant sizers at the preoperative appointment. Each additional 3D scan created after a consultation will result in a $100 fee. Changes in sizing or style after your consultation will result in the following fees: Resizing $100; Change of implants after PreOp $250. This is to ensure implants are in stock, ordered and arrive in time for your surgery. Implant size change fees are non refundable. Size changes after pre op cannot be guaranteed.
Additional Fees:
The fees charged for this procedure do not include any potential future costs for additional procedures that you elect to have or require in order to revise, optimize, or complete your outcome. Additional costs may occur should complications develop from the surgery.
For the safety of our patients and in accordance with our surgery center standards, all patients must have a Body Mass Index (BMI) of 28 or below on the day of surgery. If your BMI is above 28 on the day of your procedure, an Extended OR Time Fee will be charged. In addition, the doctor in his sole discretion may cancel your surgery in relation to a high BMI. Please note that in the case of cancellation, a 100% forfeiture of the total surgical quote will ensue, with no refund issued.
Complications are Covered:
If you have an urgent complication from surgery that can be managed in our office or surgery center, you will not be charged. This may include surgery or treatment for: hematoma, seroma, infection/abcess or cellulitis. In these cases, as long as we are able to care for you "in house", we will not issue any charges. If your complication requires a hospitalization, you will be responsible, with your health insurer as applicable, to cover the costs of hospitalization.
Abdominoplasty and Labiaplasty Guarantee:
The results from your abdominoplasty and/or labiaplasty surgery are guaranteed for one year after surgery as long as the doctor feels that in their sole discretion a material improvement in your results can be achieved with a revision surgery. Concerns regarding your surgical outcome must be brought to our attention within one year of your surgery date. You must be at your pre-operative weight and must not have experienced pregnancy or other health related complications or issues in that timeframe.
Transportation:
You are responsible for arranging adult transportation to and from your surgery. Surgeries that are delayed/canceled due to failure to arrange adult transportation are subject to above fees. For safety, an uber/cab driver does not fulfill this requirement.
The Guest House:
Pending availability, you ("Guest") may be invited to The Guest House ("TGH") free of charge. This is a temporary, revocable license. It is not a lease or rental agreement and does not create a landlord-tenant relationship. This right is temporary. TGH is a residential property. It is not a medical facility. No medical care is provided at TGH. The Guest agrees to release, indemnify, and hold harmless Oppenheimer Plastic Surgery LLC, its owners, staff, and affiliates ("OPS") from any and all claims, damages, or expenses arising from their stay.
Confirmation:
I have read and understand the above payment policy. I will receive a copy by email on completion.
Consent to Treatment and Related Authorizations
CONSENT TO TREATMENT:
The undersigned authorizes Dr. Oppenheimer and staff (the “Practice”) to provide examinations, treatments, or procedures that, in their professional judgment, are medically necessary and appropriate for the above-named patient. I understand that there is no guarantee of satisfaction, outcome, or results with any medical consultation, treatment, or intervention.
CONSENT FOR PELVIC EXAMINATION:
I expressly consent to pelvic examinations, indwelling (Foley) catheter placement, and/or surgical skin preparation of my genitalia by Dr. Oppenheimer and/or associated providers, extenders, and assistants, only as medically necessary during the course of my care, and performed in accordance with accepted medical standards, with appropriate patient privacy, dignity, and professional supervision.
RELEASE OF RECORDS AND COMMUNICATION AUTHORIZATION:
I authorize the Practice to furnish affiliated entities involved in my care, billing, operations, or legal compliance with information concerning my treatment as necessary to complete care or as required by law, including copies of my medical records. I further authorize the Practice to provide relevant medical information from my records to other physicians or medical facilities involved in my continued care. I also authorize the Practice to communicate with me and my designated Emergency Contact regarding my care via phone, text message, email, and in person.
PAYMENT AGREEMENT:
I understand that I am financially responsible for all charges for treatment received, regardless of insurance coverage. I understand that the Practice does not guarantee payment by insurance and cannot accept responsibility for disputed, delayed, or unpaid claims. The Practice reserves the right to decline further services for non-payment. Patient accounts are due four (4) weeks prior to surgery or at the time of treatment for aesthetic services. I assign insurance benefits payable to the physician or organization furnishing services. Patients who confirm office-based appointments and fail to appear (“no-show”) may forfeit associated costs. Patients who have paid in full for surgery and cancel are subject to the Practice’s cancellation fee policy.
ATTORNEYS’ FEES:
In any legal dispute arising out of or relating to this Agreement or the patient’s care, the prevailing party shall be entitled to recover reasonable attorneys’ fees and costs, as permitted by law.
CONSULTATION FEE:
$200–$300
PHOTOGRAPHIC AND VIDEO AUTHORIZATION:
I consent to the taking of photographs and/or video recordings by the Practice in connection with my medical care. Such photographs and videos shall become the property of the Practice and may be used for medical records, documentation, and preoperative or postoperative planning. Use of photographs or videos for educational, marketing, website, or social media purposes requires separate and express consent.
ACKNOWLEDGMENTS AND WAIVERS:
I understand that photographs and videos are the property of the Practice and will not be returned. I waive any right to inspect or approve photographs or videos prior to authorized use. I waive any right to payment, royalties, or other compensation arising from authorized use. I acknowledge that photographs and videos may constitute Protected Health Information under HIPAA. I understand that once photographs or videos are shared publicly with my authorization, the Practice may have limited or no ability to remove them and I authorize continued use under those circumstances. I acknowledge that I have the right to receive a copy of this authorization upon request.
TERM AND REVOCATION:
This authorization shall remain in effect for twenty-five (25) years, consistent with medical record retention and documentation requirements, unless revoked earlier. I may revoke this authorization at any time by providing written notice to the Practice. Any use made prior to revocation remains authorized.
PRIVACY AND ONLINE COMMUNICATIONS:
I understand that information disclosed under this authorization may be protected by state law and/or the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). I release the Practice from claims related to authorized uses of photographs and videos. I acknowledge that the Practice may respond to online reviews I post in a general and non-identifying manner that does not disclose protected health information.
DIGITAL COMMUNICATION AUTHORIZATION:
I authorize the Practice to communicate with me via digital means, including email, text messaging, and direct messaging on social media platforms. I understand that electronic communications may involve risks of unauthorized access during transmission or after delivery to the address or number I have provided. The Practice will take reasonable steps to protect communications prior to transmission and will use the minimum necessary protected health information when communicating with me.
MEDICAL HISTORY REPRESENTATIONS:
I understand that the Practice relies on the accuracy and completeness of the medical history I provide. I will not hold the Practice responsible for errors or omissions in the medical information I disclose.
ARBITRATION AGREEMENT:
THE PATIENT, OPPENHEIMER PLASTIC SURGERY LLC, THE SODO SURGERY CENTER LLC, AND ANY AFFILIATED PROVIDERS AND STAFF (“PARTIES”) IRREVOCABLY AGREE TO RESOLVE BY DISCUSSION IN GOOD FAITH ANY DISPUTE (“DISPUTE”) ARISING OUT OF OR RESULTING FROM A CONSULTATION, TREATMENT, PROCEDURE, OR SURGERY, INCLUDING BUT NOT LIMITED TO QUESTIONS OF QUALITY OR STANDARD OF CARE, LIABILITY, ARBITRABILITY, AND THE EXISTENCE, VALIDITY, AND SCOPE OF THIS AGREEMENT. IF THE PARTIES ARE UNABLE TO RESOLVE THE DISPUTE WITHIN SIXTY (60) DAYS AFTER WRITTEN NOTICE, THE DISPUTE SHALL BE SUBMITTED TO FINAL AND BINDING ARBITRATION BEFORE A SINGLE ARBITRATOR SELECTED BY THE PARTIES IN ORANGE COUNTY, FLORIDA. THE ARBITRATION SHALL BE GOVERNED BY THE REVISED FLORIDA ARBITRATION CODE AND ADMINISTERED BY THE AMERICAN ARBITRATION ASSOCIATION IN ACCORDANCE WITH ITS COMMERCIAL ARBITRATION RULES. JUDGMENT ON THE AWARD MAY BE ENTERED IN ANY COURT HAVING JURISDICTION. IF A COURT DETERMINES THAT ARBITRATION IS NOT BINDING OR PERMITS LITIGATION TO PROCEED, THE PARTIES WAIVE ANY RIGHT TO A TRIAL BY JURY.
NOTICE OF PRIVACY PRACTICES:
By my signature below, I acknowledge that I have reviewed the Oppenheimer Plastic Surgery Notice of Privacy Practices.