SECURE PAYMENT PROCESSING
CONSULTATION FEES
In office and video consultation fees are $800 which includes 3D CT scans with a detailed 1 hr or longer surgical consult. This includes simulation of possible results and reviewing an extensive collection of before and after of prior patients. We highly encourage patients to visit our office in either the San Francisco Bay area or beautiful Los Angeles | Marina del Rey, California for an in-person consultation with Dr. Keojampa. Consultation fees will be applied to surgery if you choose to proceed with Dr. Keojampa.
Consultations for both in office and remote video approximately last 1 hour or more depending on the necessary time needed to review all your questions.
Scheduling a consultation does not constitute an automatic offer of surgery. Patient fitness along with appropriate candidacy will be reviewed during the consultation.
SURGERY COST | FINANCE | INSURANCE COVERAGE
A nonrefundable $10,000 deposit is due at the time a surgery date is booked and the full balance is due 8 weeks before surgery. Cash, check and credit cards (MasterCard, VISA) are all accepted. A deposit is forfeited if surgery is canceled. Deposit is also forfeited if rescheduled within 8 weeks of surgery without a medical reason and proper documentation.
Total remaining balance must be paid by bank wire transfer, cashier’s check, or cash.
Our practice, Keojampa MD, is NOT contracted with any insurance providers and is considered out of network. We do NOT accept insurance as payment with rare exceptions. Your insurer MUST sign a letter of agreement to guarantee payment for services otherwise the full payment for surgery will be required in advance. A letter of agreement is a binding legal contract and will state the intent to pay for the agreed upon charges covered under the pre-approval.
FFS insurance coverage is NOT common and often many insurers will place an exclusion from their health plans. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval.
The No Surprises Act took effect on January 1, 2022 and provides patients financial protections against surprise medical bills, and prohibits balance billing for certain out-of-network (OON) care. Keojampa MD will provide Surprise Billing Protection Form for applicable patients. The approved CMS protection form contains a estimate of charges for the procedures, a clear statement that consent is optional, and by signing the form, the patient agrees to pay more for out-of-network care.
Please acknowledge & understand that if surgery is cancelled and not rescheduled, or not completed, the $10,000 nonrefundable deposit will not be returned to you.