Thank you for choosing Dr. Klump as your Dental Health Care Provider. We are committed to your treatment being successful. Thefollowing is a statement of our financial, insurance, andother practice policies that we require you read and sign prior to receiving treatment.
NEW HYGIENE PATIENTS
If you are a new patient and seeing our hygienist, you can expect to have x-rays. If you have had x-rays taken within the pst 6 months, we can have them transferred to our office. In order for Dr. Klump to properly diagnose treatment, we will need to have these in our office prior to your appointment. If no x-rays are available, Dr. Klump will NOT do an exam.
IF YOU HAVE INSURANCE
We are in network with several insurance companies and will be happy to answer any questions you have have. We will file and accept assignment on these plans; however, the requirements set by your insurance and our office states that you must pay your co-payment and/or deductibles at the time of service. THIS amount is an ESTIMATE of your portion and can therefore change. With regards to all other insurance plans we will, as a courtesy to you, file a completed insurance form to your carrier. ONCE AGAIN, we can only estimate what they will pay. Your estimated co-payment and any additional
amounts owed will be collected at the time of service. WHETHER AN "IN NETWORK" PLAN OR NOT, ULTIMATELY YOUR ARE RESPONSIBLE FOR ANY FEES REGARDLESS IF YOU RECEIVE BENEFIT FROM YOUR INSURANCE CARRIER OR NOT.
All children under the age of 18 MUST be accompanied by a parent or guardian for treatment to be done. We will collect any fees from the accompanying adult at the conclusion of the appointment.
As a COURTESY to you, our office attempts to confirm all appointments. This will be done approximately 2 days before the appointment. It is vital that we have current phone numbers to be successful in this process. When we call, please inform us of any medical chagnes, medications and if there are any dental issues that we need to inform the hygienist or Dr. Klump about prior to the appointment. If you are unable to confirm your appointment, we may reschedule it. Also, if you are unable to keep your scheduled appointment, we require 2 days notice. This enables us to fill that opening that is created by the canceled appointment. By signing electronically below, I have read, understand, and agree to these policy terms.