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Thanks for giving John such good care. We appreciate your service and will ask if you will do it again in a year.

Jeanne H., Special Needs Patient

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316.788.5939

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Payment Information

Anesthesia Charges

Anesthesia charges are calculated using a formula designed by the American Society of Anesthesiologists, and is universally used by anesthesia providers and insurance companies. In this formula, there is a base unit value for any type of procedure performed according to the area of the body where the procedure is performed. Dental procedures are given a base unit value of five units.

Additionally, all time involved in the anesthesia care is accounted for in 15 minute increments. These are called time units. Base units (5) plus time units equal the total units for the case. The total units multiplied by the conversion factor (cost per unit) equals the anesthesia charge, in dollars. Conversion factors change periodically, so call us for the most recent information.

Payment for Services

Some charges will be covered by insurance. Many times, medical insurances will pay the anesthesia charges for children under the age of six, patients with a mental or physical handicap, or patients with a medical necessity. We participate in Blue Cross Blue Shield of Kansas (BCBSKS) only. We can do a predetermination with this insurance to find out if there is coverage for our services.

Other insurances will do predeterminations, but we don’t offer this through our office. Our staff will be glad to assist you with the information you’ll need when contacting your insurance company to determine if you’re covered. You can usually accomplish the predetermination over the phone, but we suggest you have your insurance company send you a letter of confirmation.

We do expect payment on the day of service. This would be all BCBSKS deductibles and co-payments, as well as payment in full for all other insurances or those without insurance coverage.

Filing with Insurance: Your Rights

We realize there are instances in which you don’t want to file a claim with your insurance company. You may, in fact, desire your insurance company not know anything about the service you receive, for any reason.

Federal “HITECH” law allows you to request that we not notify your insurance company, nor file a claim with them, if you do not want them to know about the service you’ve requested. You may request a private contract with your healthcare provider. You are then allowed to pay, out-of-pocket, for the service without your insurance company’s knowledge.

If we can provide further information or you would like to sign a private contract for services, please contact our office.

Types of Payment Accepted

We accept cash, personal checks, cashier’s checks, money orders, traveler’s checks, Visa, Mastercard, Discover, and bank debit cards. Additionally, we offer a payment plan:

Care Credit

Care Credit offers interest-free financing for up to 6 months. See www.carecredit.com or call our office for details.

MAILING ADDRESS: 727 N Baltimore, Derby, KS 67037