Thank you for choosing Prairie Oral Surgery as your health care provider. We are grateful that you are entrusting your care to us. Please understand that payment of your bill is considered part of your treatment experience. The following is a statement of our Financial Policy that you will be asked to review and sign before receiving services in our office.
You Are Responsible For Your Bill
As the recipient of our services, you are responsible for the charges associated with each of the services you received during the course of your treatment. You (or your guardian, if you are a minor), must pay for the services you receive from our office. You may have insurance, financial support from family members, or non-resident persons who may pay all or a portion of your bill on your behalf, but you remain legally responsible for your bill.
Payment For Our Services is Due on the Day You Receive Services
Payment for our services is due on the day you receive services. The amount collected on your day of surgery will be the estimated patient responsibility after taking into consideration the amount your insurance policy will cover. If you have no insurance, the entire amount of your bill will be due on the day of your appointment. If this amount is difficult for you to pay out of pocket on the day of your appointment, we will be happy to discuss alternate financing plans available to you through financing companies outside our office. We are unable to finance your treatment directly through our office. You cannot pay your bill “over time” or “on account” through our office. Our office provides medical services, banks provide financing services. We accept visa, master card, discover, care credit, personal checks or cash as payment for your services. Should you have questions regarding an estimate for your treatment or alternate payment options for your services, please call our business office directly at 701-478-4404.
If You Have Insurance
If you have dental or medical insurance, we will assist you in receiving the maximum allowable benefits available under your insurance policies. We will file a claim for services on your behalf, and in many cases we can receive some payment directly from your insurance company. However, you remain responsible for your bill, not your insurance company. If, after a reasonable amount of time, we are unable to receive payment for services on your behalf after following normal claim submission procedures, we will expect payment in full from you.
We Will Collect the Amount You Will Owe at Your Appointment
Depending on your insurance, we will collect on the day of your appointment the amount estimated to be your responsibility. We determine this amount by estimating the services and charges we think you may receive and then subtract the amount we believe your insurance company may pay on your behalf (based on the insurance information you give us). We then ask you pay the remainder on the day you receive services. You may require additional services (or fewer services), in which case your charges may be greater or less than our estimate. Please keep in mind that this is only an estimate and we cannot pre-determine the exact services you will require or guarantee the final payment amount from your insurance companies.
The Care Credit Financing Plan
We have made arrangements with an excellent financial servicing company called CARE CREDIT, to provide financing options for you to pay for services over a number of future months. This financing service can offer low-interest, or in some cases, zero-interest options for paying for your dental services.
Questions? Please Ask Our Staff
Our staff is trained to answer your questions regarding your bill and payment arrangements. We do our best to stay on top of insurance plans and would be happy to help you try to understand all of the confusing details and provisions found in many insurance plans. We don’t mind talking about money and bills, so please, feel comfortable discussing our charges and your bill.
ATTENTION!
Before viewing these forms you
will need Adobe Acrobat Reader to
view and print these forms.
Prairie Oral Surgery, Ltd.
Edward F. May, D.D.S.
2585 23rd Avenue South
Suite #A
Fargo, ND 58103
Phone and Fax
Office: 701.478.4404
Fax: 701.478.4407
Toll Free: 866.478.4404