 We are committed to providing you with the best possible care, and we are pleased to discuss our fees with you at any time. Your clear understanding of our Financial Policy is important to our professional relationship. Please ask if you have any questions about our fees, Financial Policy, or your responsibility.
- Cash, check, or credit card is required at all first visits.
- For fees under $300.00, payment by cash, check, or credit card is required at time of service
- For fees in excess of $300.00, payment arrangements may be made in advance through our financial secretary.
- YOU ARE RESPONSIBLE FOR THE TIMELY PAYMENT OF YOUR ACCOUNT - 1.5% per month (18%APR) will be charged to unpaid balances over 30 days.
- MINORS ACCOMPANIED BY AN ADULT - The adult accompanying a minor, and his/her parents (or guardians), are responsible for FULL PAYMENT at the time of service.
- UNACCOMPANIED MINORS -The parents (or guardians) are responsible for FULL PAYMENT. Non-emergency treatment will be denied unless charges have been pre-authorized to an approved credit plan, to a VISA/Mastercard/Discover Card, or paid by cash or check at the time of service.
- There is a $17.00 charge on all returned checks.
We are pleased that you have a dental co-payment policy. We will do everything we can to help you maximize your benefits on a yearly basis. Please keep several important facts in mind:
- We ask that you understand that we neither work for the insurance companies nor do we wish to. We work 100% for you. We want to help you maximize your benefits, but we also do not want to be controlled by insurance companies nor the benefit packages they offer. Insurance is a contract between you and your insurance company. We are not a party to this contract, in any case. We will not become involved in disputes between you and your insurance company regarding deductibles, co-payments, covered charges, secondary insurance, “usual and customary” charges, fee lists, etc., other than to supply factual information as necessary.
- You are responsible for the full balance of your account. Late payment charges of 1.5% per month (18%APR) will be added to unpaid balances over 30 days from the date of service.
- We will provide you with a printed summary of services rendered. You can staple this summary to a form you have completed and then mail in to your insurance company. If you supply us with the following information, we will generate an insurance form for you that you can send directly to your insurance company. It is YOUR RESPONSIBILITY to notify us of changes in your insurance if you choose to have us provide you with a printed form. The information we will require is:
- the employee’s name, social security number and birth date
- name and mailing address of insurance company
- name and address of employer
- group number or policy number, if any
In either case, YOUR INSURANCE COMPANY WILL REIMBURSE YOU DIRECTLY as we DO NOT accept assignment of benefits (which means we do not wait for your insurance company to pay us).
THANK YOU FOR UNDERSTANDING OUR FINANCIAL POLICY. Please let us know if you have and questions or concerns.
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