Paramount Plastic Surgery insurance form

Payment Options, Fees & Insurance:

We have many options for you:	Looking good shouldn't be something that only the wealthy should be able to do. When you look good, it helps you feel good, which is a tangible investment in your earning potential. Invest in yourself. We have the following options for those who wish to private pay their treatment: Financing Payment plans

Insurance Plans:	Blue Cross/ Blue Shield PPO Aetna/ US Healthcare HMO/PPO/POS Coventry HMO Southcare PPO United Health Care HMO/PPO/POS Georgia First PPO (Georgia State Merit/ Employees) Humana/TRICARE/ Champus Cigna HMO/PPO/POS Medicare Medicaid

Fees & Deposits:

Consultation

The day of your consultation, you will be required to pay a $100.00 fee, which will be credited toward Dr. Jeffords' surgical fees when the surgical procedure is performed. We do require a credit card to reserve your consultation date with Dr. Jeffords.

Estimated Expenses

You will also be given a written estimate of the costs involved in your upcoming surgery.

Deposits

You will be required to pay a $500.00 deposit to schedule and hold your surgery date, which will also be credited toward Dr. Jeffords' surgical fees.

Balance

The remainder amount for Dr. Jeffords is required to be paid in full, two weeks prior to your surgery date.

Surgery

Surgical center fees are required the day of your surgical pre-op appointment, to be paid directly to the surgical center.

Anesthesia

Anesthesia costs are to be paid one week prior to your surgery date.

Any other fees involved and/or working with your insurance carrier if applicable, will be explained to you by our staff.

Questions? e-mail the doctor at kkj@paramountplasticsurgery.com

Paramount Plastic Surgery