INFORMATION ABOUT YOUR DENTAL INVESTMENT
We feel strongly that our patients deserve the best possible care we can provide. In an effort to provide and maintain that high quality care, we would like to share some information with you about financing your dental care. Our hope is that by providing the following information we can prevent misunderstandings and that you will be comfortable discussing financial and insurance matters with us. We urge you to consult with us if you have any questions regarding our fees and/or services.
1. At each visit we ask that you make full payment unless other arrangements have been made. If you have insurance, we ask that you pay the portion which your insurance does not pay on the date of service.
2.Personal Check, Visa, MasterCard, Discover, American Express, and Apple Pay may be used for payment of your account.
3. Outstanding account balances are due in full within 30 days of service unless other arrangements have been made. A finance charge of 1.5% per month (18% per year) will be assessed to balances over 30 days past due regardless of pending insurance coverage. We encourage you to check with your insurance company if they have not made payment within 30 days of your treatment date.
4. Many patients are under the impression that if they have insurance coverage, it is the insurance company who owes the provider for services rendered. The insurance contract is between the patient and the insurance company. Therefore, the patient is responsible for all account balances regardless of any insurance benefit. We are experts in insurance processing and will be happy to bill your insurance on your behalf. Please be sure to provide us with correct and complete information so we may process your claim in an accurate and timely manner.
5. Many insurance plans state that provided services will be covered at 50%, 80% or even 100%. We have found that many plans cover less depending upon the plans established "usual and customary fees." The benefits paid by your plan are largely determined by how much your employer/union paid for the plan. Please be aware that insurance companies will pay a claim percentage based on their "usual and customary" fees, and not our actual fees. Thus, your insurance coverage may be less than you expected. We encourage you to be familiar with your plan benefits.
6. The parent that brings a minor in for treatment and signs below as guarantor is responsible for payment of services rendered. Our office does not recognize agreements between parents accepting or denying financial responsibility for dental fees.
7. Delinquent accounts will be referred to collection at the discretion of the office manager. There will be a $20.00 collection processing charge for those accounts referred to collection. There is a $20.00 charge for checks returned for non-sufficient funds.
8. We reserve the right to charge a broken appointment/late cancellation/no show fee of $50.00 per hour for any appointment that is changed or missed by patients with less than 48 hours notice.
Iunderstand the terms and conditions as stated above and accept full financial responsibility for any treatment rendered.