Thank you for choosing Lansdowne Dental Associates as your dental care provider. We are committed to your successful treatment and outcome. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our Financial Policy, which we require you to read and sign prior to any treatment.
All patients must complete our Information Form and provide insurance facts before seeing the doctor.
Applicable payment is due at the time of service. We accept cash, checks, VISA/MASTERCARD and PayPal.
We will gladly submit your treatment to your insurance company. We cannot bill your insurance company unless you give us your insurance information. Your insurance policy is a contract between you and your insurance company. We are not party to that contract. If your insurance company has not paid your account in full within 35 days, you are responsible to submit payment in full to our office within 10 days of notification.
Please be aware that some, and perhaps all, of the services provided may be non-covered services and not considered reasonable and necessary under your dental insurance.
All co-pays and deductibles are due prior to treatment. In the event that your insurance changes to a plan where we are not participating providers, refer to the above pararaph.
Usual and Customary Rates
Our practice is committed to providing the best treatment for our patients and we charge what is usual and customary for our area. You are responsible for payment regardless of any insurance company's arbitrary determination of usual and customary rates. Your up front charges may include a 10% allowance for your insurance company's arbitrary adjustment of the fee schedule.
Unless cancelled at least 24 hours in advance, our policy is to charge for missed appointments at the rate of $50 for each half hours of the scheduled appointment time. Please help us serve you better by keeping scheduled appointments.
Thank you for understanding our Financial Policy. Please let us know if you have any questions or concerns.
I have read this Financial Policy. I understand and agree to this Financial Policy.