Thank you for choosing LOH Anesthesia Services LLC to provide your moderate IV sedation during your dental procedure. I am committed to providing you with the highest quality of anesthesia care, so that you may attain optimum oral health.

By providing anesthesia services in the dental office setting, I am able to significantly lower cost when compared to a hospital or surgery center. Unfortunately, most dental insurance companies and standard plans do not cover the cost of moderate IV sedation for dental procedures. The fee for anesthesia is an out-of-pocket cost. Anesthesia is billed based on anesthesia time and varies with each case. A quote will be given to you during your preoperative consultation with your Certified Registered Nurse Anesthetist (CRNA).

A non-refundable down payment of $250.00 is due at the time of scheduling the appointment.

• The deposit will be applied to your final charge.
• The balance is due and payable at the time the service is provided.

All charges are your responsibility regardless of your insurance coverage. I must emphasize that as your anesthesia provider, my relationship is with you my patient, not with your insurance company. Your insurance policy is a contract between you, your employer, and your insurance company. My office is not a party to that contract.

ACCEPTABLE FORMS OF PAYMENT:

• Cash
• Debit card
• Credit card
• HSA/FSA card