Thank you for choosing our office to serve your dental needs. We are committed to providing you with the highest quality care. All recommended treatment is to ensure your optimum oral health. Your clear understanding of our financial policy, which is an agreement between you and our practice, is important to our professional relationship.
Appointment:
Your appointment time has been reserved specifically for you. We require 24 hour notification/cancellation prior to your scheduled appointment time. Missed appointments represent a cost to us, to you, and to other patients who could have been seen in the time set aside for you. Patients that miss a scheduled appointment, without notifying our office twenty-four (24) hours prior to their scheduled appointment time, are subject to a $25.00 missed appointment fee that may be added to your account. Payment of any outstanding missed appointment fees will be required prior to scheduling future appointments with our office. Patients that miss three (3) appointments within a one (1) year period may be dismissed from the practice due to a failed professional relationship.
If you arrive more than ten (10) minutes after your scheduled appointment time, we will do our best to accommodate you. However, in the event we are unable to work you into the provider's schedule, it will be necessary to reschedule your appointment.
Primary lusurance Plans
We are considered an "out of network" provider. For most primary insurance plans, we will be happy to submit your claim for services provided. However, it is your responsibility to know what benefits your insurance plan provides. Insurance plans vary considerably, and we cannot predict nor guarantee what part of our services will or will not be covered by your insurance. It is your responsibility to verify that services received are covered. We will collect an estimated copay and deductible and time of service for most dental services.
Please note that many insurance plans will state "100% coverage", or another percent coverage, for different categories of dental care. This means they will cover that percentage of the insurance company's determined list of approved fee schedules, not on the actual fees charged by our office (remember- we are an "out-of-network" provider and do not have contracted fees with insurance companies). For example, if you have 100% coverage for preventative care, it does not mean your plan will cover the entire cost of a cleaning, exam, xray images, ect.
You are responsible for any remaininq balance after payment is received from your insurance plan. If you receive payment directly from your insurance, often in the form of a check, you should notify our office and remit payment to us for services rendered. You may be required to pay in full on the date of service if you receive insurance reimbursement directly.
Patient Information/Proof of Insurance
It is your responsibility to provide us with accurate and timely insurance and demographic information. Upon arrival for every visit, you will be required to provide updated information regarding changes to your mailing address, contact numbers and insurance coverage. You will be required to provide us with a copy of your insurance card. This includes the insurance card and any other pertinent information that will assist in making sure that your visit is billed appropriately. If services are denied or not covered as a result of inaccurate or untimely information provided to our staff, you will be responsible for that payment of all charges associated with that date of service. Additionally, if services are retroactively denied for a previous date of service due to insurance eligibility issues, you will be responsible for the payment of all charges associated with that service. We are not a Medicare or Medicaid provider.
Insurance, Deductibles, Co-Insurance & Delinquent Patient Account Balances
At the time of your visit, you are responsible for the payment of all insurance deductibles and co-payments according to your specific insurance plan as well as any delinquent patient account balances. If you are unable to pay those amounts and prior financial arrangements have not been secured, your appointment may need to be rescheduled.
Non-Covered Services
Our providers follow appropriate, evidenced based treatment planning guidelines based on your oral health and needs. Please be aware that some of the services you receive may not be covered, in part or in full, based on the terms and benefits of your specific insurance plan. You will be financially responsible for the cost of services provided that are not covered by your insurance company. Treatment recommendations are based on "what is best for your oral health" as proposed by our providers, not based on policies adopted by insurance companies.
Secondary Insurance Plans
Beginning January 1, 2022, we will no longer be accepting or submitting claims with secondary insurance plans at Staton Family Dentistry. This decision was made in order to improve the efficiency of our insurance filing process. However, patients who hold secondary insurance plans may still choose to file their claims personally, and receive direct reimbursement from their insurance companies (often in the form of a check paid directly to the patient). We can provide you with printed statements and any information the secondary insurance company requires for claim processing.
Self-Pay
In order to address the heeds of our patients with no insurance coverage, our office offers a 3% discount on crowns and bridges when paid in-full at time of service (cash or check).
Returned Checks
A $35.00 return check fee may be charged to your account for any checks returned for insufficient funds. The returned check fee is your financial responsibility and payment of any outstanding return check fees will be required prior to scheduling future appointments with our office.
Patient Statements & Patient Account Balance
Statements representing the patient responsibility portion of your account are generated and mailed approximately every sixty (60) days. This timeframe may be extended by us if the account has pending insurance claims. Please contact our office if you have questions about your patient statement. Patient statement balances are due as listed on the patient statement due date.
If you have received three (3) statements and have not paid your balance in full nor have you made a payment arrangement with our office, your account will be considered delinquent. Delinquent accounts may be forwarded to a collection agency. Patient accounts forwarded to a collection agency will be charged for all costs and expenses associated with the collection of your account including, but not limited to our reasonable attorney's fees. Additionally, if your account is forwarded to a collection agency, you may be dismissed from the practice due to a failed professional relationship.
CareCredit
CareCredit is a payment option for patients that qualify. CareCredit is used to make dental care affordable. For qualified cardholders, services provided that range from $200-$499 qualify for a 6-month interest deferred plan. Services over $500 qualify for a 12-month interest deferment. Be sure to ask our staff for additional information or to complete an in-office application. You can also visit them online at www.carecredit.com from your phone or home computer. It takes just a few minutes to apply and receive the results.
The cardholder whose name is printed on the card must be present in order to sign for payment.
Trust/Communication.
Our goal is to provide the best care and dental experience possible. We put your oral health first and will make recommendations on what is best for you, not what insurance covers, etc. We feel trust and a clear understanding is essential to a successful professional relationship. If, at any time, you do not understand recommended treatment or the treatment process, please feel free to discuss. Our goal is to avoid any risk of miscommunication or loss of trust.
**Due to change in practice ownership in 2021, you may be required to pay balances due to "Ronnie L. Dyer, DMD" separately from balances payable to "Staton Family Dentistry".**
Updated: January 1, 2022