NRV Oral & Maxillofacial Surgery, LTD.

Professional Park One 6061 Belspring Road

100 Professional Park Dr., Suite 1Radford, VA 24141

Blacksburg, VA 24060

Telephone (540) 951-8777Telephone (540) 633-5700

Fax (540) 951-9642Fax (540) 633-5995

This is presented to acquaint you with the policies of this office in an effort to make your visit as pleasant as possible and to eliminate some potential misunderstandings.

Surgical Fee and Payment

Our fees are determined by the time involved and the complexity of the procedure, and are the same for all patients, whether or not they have insurance. Our office policy is payment at the time of service for all treatments unless other arrangements have been made in advance. This allows us to keep the cost of providing service lower without reducing the quality of care we provide to you. The following methods of payment are available:

a. Cash or Check (local)

b. MasterCard, Visa or Discover

c. Care Credit or Capital One Healthcare Finance

d. Emergency Care – As a general rule this is to be paid for at the time service is provided.

e. Arrangements other than these must be authorized by the business office.

Insurance

Your insurance company may pay ALL, PART, or NONE of your charges from this office. The percentage you receive is determined by how much your employer has paid for coverage. The less paid for insurance, the less you will receive in benefits. Therefore, YOU are responsible for the payment of your bill. As a courtesy to you, we will fill out insurance forms and bill your insurance company. However, you are expected to make an advance payment equal to the amount that we estimate will not be paid by your insurance company. Any subsequent payments from your insurance company that exceed the remaining balance of your account will be refunded to you.

“Dental insurance is a highly complex area that creates confusion for many dental patients. The complexities of dental insurance and a lack of sufficient information provided by some insurance companies make it almost impossible for some patients to properly understand their benefits. Even more confusing is understanding how to properly work with your dental insurance company to achieve the highest level of benefits.”

“Dental insurance is a contract between your employer and a dental insurance company. The benefits that you will receive are based on the terms of your contract that were negotiated between your employer and the dental insurance company and not your dental office. The goal of most dental insurance policies is to provide only basic care for specific services…the benefits you receive from the dental insurance company for your current insurance plan have nothing at all to do with you or achieving a high quality complete result.” –Contemporary Esthetics and Restorative Practice Publication

We will file primary insurance only. Secondary insurance will be the patient’s responsibility. We will send bills to you monthly whether we have filed your insurance or not. This is to keep you informed of all charges and of any payments received from your insurance company. You are expected to pay the balance of your account after your insurance company has paid or if more than 30 days have passed since your insurance claim was filed.

Our staff will help you receive the maximum benefits available under your policy. However, please remember that YOU are fully responsible for all fees charged by this office regardless of insurance coverage.

RADIOGRAPHS

If your appointment is for consultation regarding evaluation for surgical care we will usually need a panoramic radiograph (X-RAY) prior to the consultation. We have found radiography to be necessary for more complete assessment of diseases of the jaws. This radiograph provides us with an overall view of the entire upper and lower jaws and the relationship of structures, such as displaced wisdom teeth, to adjacent nerves, sinuses, and teeth.

(PLEASE KEEP THIS SHEET FOR FUTURE REFERENCE)

Communication

Last, but certainly not least—we realize that misunderstandings can occur and that open lines of communication are important in resolving them, so please let us know if there is any concern on your part with the surgery performed, bookkeeping, insurance, or any other aspect of our office procedures.

During normal office hours please call (540) 951-8777. If you have an emergency problem outside of normal office hours, the Doctors can be reached by calling the Montgomery Regional Hospital at (540) 951-1111.

We sincerely hope that your visit with our office will be satisfactory.

PRE-OPERATIVE INFORMATION

Anesthesia

Different procedures require different types of anesthesia. In our office we use the following:

Local anesthesia — An injection in the mouth to numb or anesthetize the area where treatment is to be rendered.

General Anesthesia (IV Sedation) — The intravenous injection of drugs into a vein of the arm to produce relaxation and sleep if required. Local anesthesia is usually used in conjunction with this type of anesthesia.

Nitrous Oxide Sedation — The nasal breathing of a relaxing, mild gas, used in conjunction with local anesthesia and IV sedation.

Pre-Operative Instruction

(for General Anesthesia – IV Sedation)

1. The night before the surgery eat a light, easily digestible meal, consume no alcoholic beverages, and retire early.

2. The day of your surgery:

a. If your surgery is in the morning, have nothing to eat or drink after midnight (not even water).

b. If your surgery is in the afternoon, a clear liquid breakfast is permitted before 7:00am (water, tea, coffee, broth, plain jello or juice), then nothing after 7:00am (not even water)

3. Your mouth and teeth should be well cleansed immediately before your appointment.

4. A responsible person must be available to drive you home after the surgery. Under no circumstances should you plan to drive an automobile the day of the surgery. This person should remain in our office during your surgery to receive instructions for your care. Under no circumstances should they leave.

5. Wear comfortable, loose fitting clothing with loose sleeves. Do not wear jewelry or heavy makeup.

Appointment Changes

On occasion an emergency situation may arise that would require our rescheduling your appointment. We will call you as early as possible and will use the telephone number you gave us when you made your appointment. Giving an alternate telephone number would be advisable.

In the event that you find it necessary to change your appointment or if you will be late for your appointment, we would appreciate as much advance notice as possible. We reserve the right to charge for missed appointments.