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Payment & Cancelation Policy
Reconstructive Surgery Payment Policy
I have authorized payment of medical benefits to Crawford Plastic Surgery. If denied, non-covered, or remain unpaid by my insurance carrier, I will be responsible for the balance due. I understand and agree that any credit granted shall be paid promptly in accordance with terms and agreements, that the credit grantor may add one and one half percent (1 ½ %) per month to any balance owed and in the event of default to pay reasonable collection charges and/or court costs and attorney fees.
Self-Pay/Cosmetic Surgery Payment and Cancellation Policy
We will reserve a specific date for your surgery once a non-refundable deposit of $500 is received. Our billing office will accept cash, credit cards (Visa, MasterCard, AMEX, and Discover), cashier’s checks and money orders. The above quote represents a cash/credit card payment. If a medical finance company is used to help finance your surgery, additional fees may apply depending on the company and payment plan chosen. The facility fee may or may not include basic laboratory work, however, any fees associated with your preoperative evaluation (labs, x-rays, or EKG) will be your responsibility. The physician’s fee does not include hospital, anesthesia, pathology, laser, post-operative materials/garments or implants of any type. The above surgeon’s fee quote will be honored for a period of 6 months from the above date. The amount for the facility fee and/or anesthesia is an ESTIMATE ONLY. The fees for the facility and/or anesthesia are subject to change at any time by the facility where your procedure is planned. If additional fees are due to the facility FOLLOWING your surgical procedure for any reason, you are responsible for these and will be billed separately. My signature below indicates that I understand the above terms and have received an explanation of the surgery scheduling process at Crawford Plastic Surgery.
We understand that a situation may arise that could force you to postpone your surgery. Please understand that such changes affect not only your surgeon, but other patients as well. Dr. Crawford’s time, as well as that of the operating room staff is a precious commodity and we request your courtesy and concern. If you need to cancel your surgery or in-office procedure less than 14 days prior to your surgery, you are entitled to a refund of 50% of your surgeon’s fees. Should you find it necessary to cancel your surgery or in-office procedure 7 days or less before surgery, you will forfeit your entire surgeon’s fee. If you need to reschedule your surgery or in-office procedure we ask that you do so as soon as possible since the operating room has been reserved for you. Procedures that are rescheduled less than 14 days prior to the procedure are subject to the above penalties if cancelled after rescheduling has occurred. By checking the "I Agree" box on our "Online Bill Pay" form indicates that you understand and agree to the above terms and conditions.