General Office Policy
1. Payments and Co-Pays are due the day of service.
2. insurance: We will file your insurance claim for you as a courtesy. With the information you provide to us, we will do our best to help you determine your dental benefits. The estimated co-pays we give you are "estimates", not a guarantee. If your insurance does not pay, you will be responsible for the dental services you received.
3. Delinquent Accounts: In the event your account becomes delinquent as a result of non-payment of 90 days or more, it will be referred to an outside agency for collection. You will be responsible for the full account balance plus any and all fees and expenses incurred by River Valley Smile Center as a result of non-payment.
4. We would appreciate at least 24 hour notice if you cannot attend your reserved time. This will allow us time to contact other patients who are waiting for an appointment to become available. Patients who repeatedly break scheduled appointments, are consistently late, or do not show up with no notice, may be put on a short call only status.
5. I give my permission to RVSC to store the confidential patient information I have provided, including account information, insurance information, and clinical information to the RVSC secure data programs. I understand that for security purposes, RVSC makes every effort to keep electronic information secure, and the RVSC program can only be accessed by internal passwords and requires a protected user ID. I understand that the dental practice is not to be held liable for any harm related to the theft of this information. I also understand that RVSC will represent all State and Federal privacy laws, as well as ethical and licensure requirements.
*For a more detailed description of the State and Federal privacy laws, a copy may be obtained on hhs.gov.