We thank you for selecting Arbor Creek Dental office for you dental needs. We will strive to provide the very best care for you. In order to do so, this sheet has been prepared to acquaint you with our financial policies.
Please be advised that for those patients or procedures without insurance coverage, payment is due in full as the services are rendered. For your convenience we accept cash, check, MasterCard, Visa, Discover Card and American Express. We also offer Care Credit Healthcare Financing applications or go online to carecredit.com for information.
Insurance Assignment and Management
In order to better serve your needs, our office contracts with Delta Dental KS, Guardian and Met Life Insurance Plans. We will be happy to assist you in filing any insurance however, it is up to each patient to know and understand the coverage, benefits, limitations, waiting periods, an exclusions of their own insurance plan. We will not be responsible if you do not follow the specific terms of your insurance agreement. Patients are responsible for paying their deductibles and co-pays at the time of service. Deductibles and co-pays are ESTIMATED for what benefits may be available. Please be advised that these estimates are just that, ESTIMATES to the best of our ability. We would be happy to pre-authorize any treatment at your request however; even pre-authorizations are not a guarantee of payment from your insurance company. Ultimately, you are responsible for any balances from unpaid claims.
We will be more than happy to file insurance claims for you in a prompt manner. We do not accept or file medical insurance. In order for us to file dental insurance on your behalf you must provide us with proper insurance information at the time of visit. If you are not able to provide this information or we are unable to verify your dental coverage, you will be required to pay in full at the time of service or you may choose to reschedule your appointment.
Please be advised that any balance on account that is over 60 days will be charged a finance charge of 18% annually (1.5% per month). Accounts that remain delinquent may be turned over for collection action with our attorney or collection agency.
BROKEN APPOINTMENTS: A specific amount of time is reserved especially for you and we strongly encourage all patients to keep their appointments. If you must change your appointment, we require at least 24 hour notice to avoid a $50.00 Cancellation Fee. (True emergencies are an exception)
Acknowledgement and Agreement
I certify that I have read, understand, accept and agree to abide, with all the terms of the financial policy above. I will not hold Arbor Creek Dental or any employee responsible for omissions I have made in the completion of information. If I provide insurance information to Arbor Creek Dental, I authorize Arbor Creek Dental to release information regarding my treatment for the purpose of filing for potential payment of insurance benefits and I grant assignment of any such proceeds to Arbor Creek Dental. I understand that Arbor Creek Dental is not allowed to give out any information to any person(s) unless I have them listed as follows: