General anesthesia. (9) Cylindrical endosseous dental implants, mandibular staple implants, subperiosteal implants and the associated fixed and/or removable prosthetic appliance when provided because of an Accidental Injury.
General anesthesia c. The plan shall provide for the payment of eighty percent (80%) of the usual, customary, and reasonable charges for major restorative services such as:
General anesthesia. All patients who need dental treatment under general anesthesia will be expected to pre-pay the FULL amount of their estimated financial responsibility BEFORE the scheduled date of their treatment. Composite (white) fillings Vs. Amalgam (silver) fillings: West County Pediatric Dentistry Services, LLC and most pediatric dental offices only use composite resin fillings “white or tooth-colored fillings”. Most insurance companies will downgrade the price of the composite filling to the price of an amalgam filling because they are waiting for approval from the American Dental Association for medical necessity. Until this passes, the cost difference in what is covered will be the patient i.e. YOUR responsibility.
General anesthesia the patient is unconscious throughout the procedure and is not arousable until the end of the procedure. The anesthesia fee includes dentist’s time plus 15 minutes to put the patient to sleep and 15 minutes for recovery. Payment is due in full at the time of service, either by cash, care credit, or credit card. Dentist’s Time Total Anesthesia Time Anesthesia Fee 30 minutes 1 hour $1,150 45 minutes 1 hour 15 minutes $1,400 1 hour 1 Hour 30 minutes $1,650 1 hour 15 minutes 1 Hour 45 minutes $1,900 1 hour 30 minutes 2 Hours $2,150 1 hour 45 minutes 2 Hours 15 minutes $2,400 2 hours 2 Hours 30 minutes $2,650 2 hours 15 minutes 2 Hours 45 minutes $2,900 2 hours 30 minutes 3 Hours $3,150 2 hours 45 minutes 3 Hours 15 minutes $3,400 3 hours 3 Hours 30 minutes $3,650 Northern Lights Dental Anesthesia - Credit Card Authorization Date of Treatment: Patient’s Name: Patient’s Birthdate: I have reviewed the financial agreement and the anesthesia fee schedule. I understand that the estimated fees are estimations based on probable treatment times and I understand that the fees may change based on actual treatment times. I authorize Northern Lights Dental Anesthesia, LLC to charge my credit card for the fees according to the time spent providing anesthesia. Signature of Card Holder Date _ (Day of Treatment) To help us better assist you, if you plan on submitting for reimbursement to your MEDICAL insurance please provide the following information: Insurance Company Subscriber Name Xxxxxxxxxx XXX ID # Group # Employer _ Insurance Company Phone Number _ _ Claims Address (on back of card) _ Credit Card Information Payment Method: □Cash □Check □ Credit Card □CareCredit If Care Credit, please select promotion: No Interest if paid in full within the promotion period: □ 6 Months □ 12 Months Reduced APR and fixed monthly payments required until payed in full □36 Months □48 Months □60 Months
