Financial Information
For your convenience, we accept Visa, MasterCard, and Discover. We deliver the finest care at the most reasonable cost to our patients, therefore payment is due at the time service is rendered unless other arrangements have been made in advance. If you have questions regarding your account, please contact us at Pickett Oral and Maxillofacial Surgery Phone Number 865-691-0918. Many times, a simple telephone call can clear up any misunderstandings.
Please remember that you are fully responsible for all fees charged by this office regardless of your insurance coverage.
We will send you a monthly statement. Most insurance companies will respond within four to six weeks. Please call our office if your statement does not reflect payments made by your insurance company during that time period. Any remaining balance after your insurance has paid its portion is your responsibility. Your prompt remittance is appreciated. We can make arrangements for a monthly payment plan, but that must be implemented prior to any actual procedures.
Financial Policy
I understand that I am responsible for my bill with Dr. Pickett with whom I have contracted for services. I understand that his office will file up to 2 insurances as a COURTESY, but that I AM ULTIMATELY RESPONSIBLE FOR MY BILL FOR SERVICES PROVIDED. A deposit and/or full payment depending on the surgery proposed will be required, which is NOT dictated by how much your insurance will or will not pay.
If I expect any portion of my bill to be reimbursed or paid by my insurance, it is MY RESPONSIBILITY to notify the office of my insurance information and provide the correct insurance card(s). This information is due no later than the date of service or I will be responsible for the account in full. This is including but not limited to covered benefits for proposed procedures and referrals from Primary Care Physicians (PCP) if required.
MONTHLY PAYMENTS ARE REQUIRED WHILE INSURANCE IS PROCESSING YOUR CLAIM FOR SERVICES. All accounts are to be paid in full 3 months from the date of service, regardless of insurance or whether we are in or out of network. A service charge of 1.5% per month (18% per year) will be added to the remaining balance of the account every month until paid in full to accounts over 90 days
When cancelling or rescheduling a surgery appointment: If more than 24 hour notice is not given to cancel or reschedule prior to an appointment for surgery a $95 No Show Fee (NSF) will be charged to the account.
I authorize release of any information to my insurance company (ies) and I authorize payment directly to Dr. Pickett. This release may also be utilized to request additional medical information from any hospital or practitioner who has cared for me.