Brandon Hodge, DDS 1020 Antebellum Circle
Hendersonville, TN 37075
Office Policies (Please read and sign below)
We are honored that you have chosen our staff to provide your dental care. Your dental health is our greatest priority. For your convenience, we would like to inform you of our office policies in advance. You may have dental insurance, which is a contract between you, your employer, and the insurance company. We must emphasize that as medical care providers, our relationship is with you, and not your insurance company. Some insurance companies arbitrarily select certain services they will not cover, and most procedures are only covered at 50% or 80%. While the filing of insurance claims is a courtesy that we extend to our patients, and we will attempt to help you understand how your policy applies, you are ultimately responsible for all fees incurred beginning on the date services are provided.
Payment in full is due at the time of service. This includes all co-pays, deductibles, and co-pay percentages. We accept cash, Mastercard, Visa, and Discover. If you need to set up a payment plan, this service is provided through Care Credit. Please ask our front office personnel for information on Care Credit.
There will be a fee of $25.00 for each returned check. In the event that your account is placed with an outside collection agency, you will be responsible for all costs incurred to collect on the account.
When you reserve time in our schedule for an appointment and fail to show, or cancel less than 24 hours before your scheduled appointment, you have prevented another patient the opportunity to use that time. Should you have a need to cancel or reschedule your appointment we ask that you advise us a minimum of 24 hours in advance of your scheduled time. Failure to notify the office will result in a $40.00 charge to your account. If you arrive late for your appointment we may need to reschedule on another day.
I hereby agree to these policies and accept responsibility for charges not covered by my insurance carrier. I also agree to reimburse Dr. Brandon Hodge for fees incurred to collect on my account, including collection fees, attorney fees, court costs, and all other costs related to the collection of my account.
I have read, understand, and agrees to these policies.