Welcome to our practice and thank you for choosing us as your dental care providers. We are committed to your treatment being successful. All patients must complete and sign our information/new patient form prior to any treatment. We ask that you please read the following office policies to familiarize yourself with our office. After reading, please sign below. Thank You.
Ironwood Children's Dentistry shall operate in a manner that does not unlawfully discriminate against people on the basis of race, color national origin, religion, sex (including pregnancy), sexual orientation (including gender identity and expression), disability, or any other basis prohibited by federal, state or local law.
FULL PAYMENT IS DUE AT THE TIME OF SERVICE
Estimates for major dental care are available. A monthly financial fee of 18% is applied to balances not paid by the 1st of the following month after treatment. There will be a $35.00 handling fee, in addition to any bank charges for any returned checks. For your convenience we accept cash, checks, Visa, Mastercard, American Express and Discover.
We must emphasize that as dental care providers, our relationship is with you and not your insurance company. Your insurance policy is a contract between you and your insurance company. Although we are happy to assist you with your insurance claims, we are not a party to that contract. In the event we do accept assignment of benefits, we require that you pay the deductible (or provide proof that you have done so) and pay the estimated portion of your bill at the time of service. We often accept assignment of insurance benefits, however the balance is your responsibility whether your insurance company pays or not. We are unable to bill your insurance company unless you give us your complete insurance information.
We allow 60 days for your insurance company to pay. In the event your insurance has not paid within a 60-day period, the bill will then be turned over to you and you will be responsible to pay within the next 30 days. At that time we also resubmit to your insurance company for the last time. A simple call to your insurance company for you will greatly facilitate the payment. Remember, payment for your dental bill is always your responsibility. We allow your insurance company 60 days to pay as a service to you. All percentages and deductibles are due in full at the time of treatment.
Remember, what we collect from you at the time of visit is only an estimate. After receiving your insurance payment, we will bill or credit your account the difference.
USUAL AND CUSTOMARY RATES
Our practice is committed to providing the best treatment for our patients and we charge what is usually and customary for our area. You are responsible for payments regardless of any insurance company’s arbitrary, out-dated determination of usual and customary rates.
APPOINTMENTS AND SCHEDULING
Please remember that once you make an appointment, the doctor’s time, treatment room, and support personnel have been reserved specifically for YOU. When we set aside this reserved appointment time for you we will consider it as time you have committed. Unless cancelled at least 24 hours in advance, our policy is to charge $25.00 per regular appointment, or $50 per sedation appointment. If a missed appointment does occur, we would ask you to pay your missed appointment fee prior to being seen. If a second missed appointment occurs, we ask that you pay your missed appointment fee prior to scheduling your next appointment. If a third missed appointment occurs, we will only be able to schedule same day appointments for you for non-emergency procedures. You will responsible for calling our office the day you would like to come in for an appointment and we will let you know what availability we have, if any, for that particular day. However, if you fail to keep the same day appointment, we will have to ask you to find another dental provider. When patients fail to arrive for the appointments they scheduled, that time is lost and could have been used to treat other people in need. We would greatly appreciate your full cooperation in regards to our offices scheduling policies.
Every operating day, we make every effort to stay on schedule and be sensitive to our patients’ time. We ask that you help us by arriving at least 5 minutes prior to your appointment. In order to keep our office operating on time, it may be necessary to reschedule your appointment if you are more than 15 minutes late for a regular appointment or 10 minutes late for a sedation appointment. If uncontrollable circumstances have occurred to make you up to 15 minutes late, there may be a possibility that you may still be seen. However, other patients that are currently scheduled will be seen first. Despite our best intent, treatment emergencies do, on occasion, arise in our schedule causing unavoidable delays. We will apprise you of any such circumstance at the earliest possible opportunity to avoid any inconvenience for you.
The parent, adult, or guardian accompanying the child during the child’s appointment, is responsible for full payment. For an unaccompanied minor, non-emergency treatment will be denied unless charges have been pre-authorized to an approved credit plan, credit card, payment by cash or check at the time of service. All children must be accompanied by their legal guardian. If an adult that is not the child’s legal guardian is bringing in the child, a signed letter by the legal guardian must be presented at the day of appointment or the child will not be able to be seen.
Please be aware that we use nitrous oxide for all appointments requiring anesthesia. The majority of insurances, with the exception of State Medicaid programs, DO NOT cover Nitrous Oxide. If for any reason you are not wanting to have this administered to your child, please let the office know before the day of the appointment. The parent or guardian bringing the child to the appointment MUST stay in the building the entire length of the appointment.
I HAVE READ THE POLICIES AND I UNDERSTAND AND AGREE TO THEM