Surgical Fees. Payment is due in full 3 weeks (21 days) prior to the scheduled surgery date. We accept Visa, Mastercard, Discover, American Express, CareCredit/Alphaeon, and Cashier Checks/Personal Checks. WE DO NOT ACCEPT CREDIT CARD CHECKS. All personal checks will be processed through TeleCheck as an electronic transfer. • If your surgery is cancelled or postponed 3 weeks (21 days) prior to surgery, your fees will be refunded. If your surgery is cancelled within the 3 weeks (21 days), you will be charged a $500.00 administrative fee and a fee for any services provided; such as laboratory work or skin care services. If your surgery is cancelled within seven (7) business days of your surgical date, an additional administrative fee of 25% of your total charges will be withheld from your refund. If your surgery is cancelled the day of the procedure, you will be charged 50% of the total charges. • Breast Reduction Procedures are considered cosmetic, unless deemed medically necessary per your insurance policy. We will file with your insurance as a courtesy; however, this does not guarantee your insurance company will reimburse. • All tissue that is removed during surgery will be sent to Pathology and the patient will be responsible for these charges. It is the patient’s responsibility to notify us regarding where their insurance prefers pathology to be sent to avoid out-of-network charges. • MEDICARE PATIENT’S: Medicare will not process any other provider’s claims (i.e. Coral Anesthesia/SaraPath) without receiving a claim from your surgeon. “Cosmetic and/or Non-Covered Medicare Services”, the patient is responsible for ALL fees associated with their surgery. Please note that Xx. Xxxxxx and Xx. Xxxxx do not participate with Medicare; therefore, ALL fees associated with surgery are the patient’s responsibility. • If postponing a surgery more than two (2) times, a 50% deposit will be required to hold a new surgical date and will be forfeited if date needs to be changed. In addition, such changes could result in dismissal from our practice at the surgeon’s discretion. • The services that are performed and paid for using a credit card or debit card are not eligible for credit card challenge. By signing this form, you are agreeing you will not challenge credit card payments once a service has been rendered. The practice encourages a complete post-op care and follow-up interaction to address any issues that might arise following services rendered. • Complimentary Botox® Cosmetic o...
Surgical Fees. We shall reimburse the Reasonable and Customary Charges for a Surgery by the Specialist/Surgeon, including pre-surgical assessment, Specialist’s/Surgeon’s visits to You and post-surgery care from the date of Surgery, subject to the maximum amount of benefits indicated in the Schedule of Benefits. If more than one Surgery is performed for Any One Disability, the total payments for all the surgeries performed shall not exceed the maximum amount of benefit stated in the Schedule of Benefits.
Surgical Fees. You will receive a copy of the surgical quote which is good for 90 days after it was provided. It expires at the end of the 90 day period. The quote is the fee due to Florida Plastic Surgery 1 weeks before your surgery. It does not cover the cost of prescriptions. There may also be fees for additional supplies. All follow up office appointments are included in the surgical fee. Any additional anesthesia fees, as a result of any complications, which may arise, are the patient’s responsibility.
Surgical Fees. The 10% scheduling deposit is non-refundable. The surgical fee does not include laboratory fees before or after surgery, pathology bills, hospital fees, prescriptions, etc; these are paid directly to the provider. A $50.00 rescheduling fee will be charged each time I reschedule my surgery date. Canceling or rescheduling the surgery within two weeks of the scheduled date is subject to a 20% charge.
