Our provision of care to you will result in a bill for our services. Following is a statement of our financial policy, which we request you read and sign prior to your treatment. In addition, all insured patients must provide insurance information before seeing the dentist.
FULL PAYMENT IS DUE AT THE TIME OF SERVICE, UNLESS WE ARE BILLING YOUR INSURANCE FOR YOU, IN WHICH CASE, ANY APPLICABLE CO-PAYMENT IS DUE AT TIME OF SERVICE. WE ACCEPT CASH, CHECK, MAJOR CREDIT CARDS AND CARECREDIT. WE DO NOT OFFER IN-HOUSE PAYMENT PLANS.
Regarding Insurance
We ask that you show your dental insurance card at time of each visit so we can set up or update the correct billing information. As a courtesy, we will bill your insurance carrier for the charges which the insurance company has agreed to pay. You are responsible for any amounts not covered by your insurance. Your insurance policy is a contract between you and your insurance company. We are not a party to that contract. If the office is not informed of specialist work (i.e. Endodontics, Periodontics, Oral Surgery) done or guidelines in your policy, such as pre-authorizations, missing tooth clause, covered and non-covered services, and we subsequently preform services that are not covered we will have to bill you directly for those charges. If your insurance company has not paid your account within 45 days, the account automatically becomes your responsibility and will become due immediately. Please be aware that some of the services provided may not be covered or may not be approved for payment under your policy, but have been deemed to be in your best interest by your dentist.
Responsibility
If you are 18 or older, you are legally responsible for your own account, regardless of who you come with, who has a contract with an insurance company or who claims you as a tax deduction. If the patient is under 18, both parents, despite divorce or other separation arrangements, or the legal guardian of the patient, are responsible for payment.
I have read the Financial Policy and understand its terms.
