OFFICE POLICIES

Financial Information

Health Insurance will not cover Cosmetic Surgery or its complications. Accordingly, Mark D. Wigod, M.D., P.A. has developed a pricing schedule for these procedures. Detailed financial policies are listed below not to be unwelcoming, but to provide honest full disclosure and avoid any future misunderstandings. Dr. Wigod strives to conduct himself beyond reproach both in and out of the operating room.

Payment Options

• Cash
• Personal Checks
• MasterCard
• Visa
• Third Party Financing
• CareCredit

Non Insurance Covered Surgery Quote Policy

Your quote for surgery with Mark D. Wigod, M.D., P.A. and its Accredited Ambulatory Surgery Center, Meadow Lake Surgery Center, details fees for the surgeon, operating room, materials, and anesthesia. The quote is valid for six months. Pathology and unexpected costs are not included. These fees are your responsibility to pay.

Your quote for surgery at an outside facility is for surgeon's fees only. The quote is valid for six months. All other fees including (but not limited to) anesthesia, OR, hospital, special materials, pathology, and unexpected costs are not included. These fees are your responsibility to arrange and pay.

Payment Policy

We are happy to have you as a patient and hope to exceed your expectations for service and results. Planning your surgery requires us to commit valuable resources to your care. Accordingly, a 10% deposit on all fees is required before reserving your OR time. This deposit must be received within three business days of scheduling or the date will be released. The balance of the full payment is then due 15 days in advance of your scheduled date.

Refund Policy and Rescheduling Policies

Mark D. Wigod, M.D., P.A. maintains refund and rescheduling policies which are fair to both the patient and surgeon. Details are provided with each quote for surgery.

Revision Policy

Our goal is to make sure that you are satisfied with your surgery. Under most circumstances, if you require a revision of your recommended surgery to achieve a result that is considered acceptable to a reasonable surgeon and patient, it will be provided without a surgeon's fee. If more than minimal office surgery resources are required (anesthesia, OR, hospital, special materials, pathology, and unexpected costs), you will be responsible for their payment. If you choose a treatment option not recommended as best by the surgeon, do not follow peri-operative instructions, or have a problem that is beyond the surgeon's control, you will be responsible for all revision fees. If you desire additional related surgeries to improve on an acceptable outcome, the fee may be full or reduced at the discretion of the surgeon. In the unlikely event you require an urgent return to the operating room outside regular business hours or you have a problem which cannot be managed as an outpatient, your care will be transferred to Meridian St. Luke's Medical Center. If you require hospital admission or treatment, you will be responsible for those charges. For cosmetic surgery patients, health insurance will not cover these costs.

Above all we want you to have a great experience and for you to recommend us to your friends. Accordingly, we will use our judgment to make sure you are treated reasonably and fairly. As we only want the best for you, we hope you will give us the same courtesy
in return.

Insurance Information

Mark D. Wigod, M.D., P.A. and its Accredited Ambulatory Surgery Center, Meadow Lake Surgery Center, are contracted with many insurance plans. The office will handle insurance billing paperwork for you. Co-pays are collected at the time of service. Deductible charges not covered by your insurance will be billed after service has been completed. Dr. Wigod also accepts patients who are out of their insurance network.

Common Insurance Plans Accepted:

• Blue Cross
• Blue Shield
• IPN
• Primary Health
• United Health Care
• Medicare