Accepted Forms of Payment:
We accept payment in the form of cash, check, debit card, credit card (Visa, MasterCard, Discover, or America Express), and CareCredit. All payments for any oral & maxillofacial surgery service will be paid for before or at the time of service.
The cost of your treatment is determined based on your examination findings and treatment needs. Payment for services to be rendered by Lucca Oral and Facial Surgery are due in full before or at the time of service.
Services billable to your dental and/or medical insurance by Lucca Oral and Facial Surgery, will be submitted directly to your dental benefit carrier (and medical insurance when applicable). We will submit claims and file any necessary supplementary material on your behalf – to help maximize any benefits available to you from your dental benefit plan and/or insurance carrier (s).
Your benefits are based on the agreement you or your employer negotiated with your insurance carrier. Benefits payable for procedures vary depending on the coverage provided by your plan and/or negotiated by your employer. We encourage discussion with your company’s human resources department if needed. We are not responsible for your plan’s decision to cover or not cover a service. We can make no guarantee of coverage or payment by a third party. You are responsible for all payments before or at the time of your visit.
If you have concerns regarding your coverage, you may contact your insurance carrier directly.
Every attempt to successfully submit claims on your behalf for out-of-network benefits in open networks will be made. We are available to assist you contacting your insurance carrier regarding out-of-network policy and coverage information if necessary.
Please let us know if you have questions about our financial policies or financing options available with CareCredit prior to your treatment.
Payments made by your benefit plan will reimbursed directly to you by your insurance carrier to the address you have on file.
Any payments that are made to Lucca Oral and Facial Surgery, that result in a credit balance on your account, will be returned to you by check or refunded to your credit card pending your preference. (Note: Please inform us if you change your address and remember to institute mail forwarding. Reimbursement checks are mailed at the end of the month to the last address we have on record and check cancellation fees may apply for any checks re-issued by Lucca Oral and Facial Surgery).
Deposits and Cancelled Appointments:
Certain procedures require an advanced order of materials, implant components, or may incur laboratory fees. These materials and fees are often unable to be returned and considered wasted. If your procedure requires that such an order be placed and fees incurred, a deposit for materials may be collected at the time your appointment is scheduled. Additionally, certain procedures requiring a block of reserved time may also require a deposit relative to the scope of your appointment on a case by case basis. High value/popular appointment time blocks will be treated similarly. We require at least 48 hour’s notice for appointment cancellations. Failure to show for the appointment will result in the forfeiture of all or a part of the down payment in order to compensate for the loss of time and/or fees incurred
I understand that my dental benefits are considered a method of reimbursing me for fees paid to the doctor and are not a substitute for payment. Some companies pay fixed allowances for certain procedures and others pay a percentage of the charge.
My signature below declares that I have read and understand the above policies and that I authorize Lucca Oral and Facial Surgery to release information necessary to my insurance/benefit providers in order to process dental and/or medical claims on my behalf.
No anesthesia-assisted procedure will begin without the presence of your escort at the time of check in. Failure to have an escort present will result in appointment cancellation and rescheduling. In addition, it is extremely important for your safety that you have nothing to eat or drink for a full 8 hours prior to the time of your scheduled appointment. Failure to comply with the fasting requirements for anesthesia will also result in cancellation and rescheduling of you procedure.
We ask that our patients arrive on time for their designated appointment. Arriving more than 15 minutes past your scheduled appointment time will result in a failed appointment. If you are having anesthesia or IV sedation, your escort must be present with you at the time of check in. No new appointments will be made unless your account balance is paid in full. Anyone who does not show for 3 appointments will be dismissed from the practice.