Dental Practice Financial Policy

Thank you for choosing our practice. We are committed to providing the highest quality care at a reasonable cost. In this era of rising healthcare expenses, we will make every effort to keep costs down. However, we will not sacrifice quality and parent care to do so. To avoid misunderstandings, we ask you to read and sign our financial policy prior to treatment.
INSURANCE: Insurance is a contract between you and your insurance company. We are NOT party to this contract. We will bill your primary insurance company as a courtesy to you. Although we may estimate what your insurance company may pay, it is the insurance company that makes the final determination of your eligibility. You agree to pay any portion of the charges for services rendered but not covered by your plan or not paid (denied) by your insurance. You must inform us if you lost or are about to lose your insurance coverage. Any services rendered after insurance eligibility terminates will be charged at our standard fees. You are responsible for your charges: Patients or their legal guardian are responsible for all charges incurred during treatment and must pay for services. You might have insurance or financial support from your family or others, but you remain legally responsible for your bill.
Payment for service: Payment is required at the time that the service is provided. If you are not covered by insurance, you must pay in full for all charges at the time of service unless prior arrangements have been made in our office. If you do not have insurance: Payment in full is expected at time of service. Financing is available through the healthcare financing program, Care Credit. If you have insurance: As a valued service to you, we will investigate your insurance benefits, estimate your out -of-pocket costs and ?le claim on your behalf. You must pay for estimated out -of-pocket expenses, such as estimated co -payments, deductibles, non-covered services or services requiring further review by your insurance carrier before treatment is initiated. To determine the amount that might be paid by your dental insurance, we can ?le a written pre -treatment estimate to your dental carrier. Most carriers require 4 to 6 weeks to complete this request, so treatment will be delayed. If you receive additional dental treatment before the scheduled procedure in our office, your estimated remaining benefits could be less or non -existent. Medical insurance carriers will not provide written pre -treatment estimates. They will only inform us if you have benefits and if the services might be covered.
An insurance estimate is not a guarantee that your insurance company will pay exactly as estimated. Your insurance company determine s the final amount paid at the time the claim is processed. Verification of benefits is not a guarantee of payment by the insurance company. Final determination is made by the insurance company at the ?me the claim is processed. Payment in full is expected 45 days after your claim has been filed by us. Insurance payments are supposed to be made by insurance within 30 days of filing. However, if your insurance has not paid within 45 days, you will need to contact your insurance company to investigate claim status. If your payment is not received within 45 days of ?ling or claim is denied, you will need to pay the balance in full at that time. The payment will be applied to an authorized credit card or may be paid by check. A service charge 1.5% per month will be added to your account if payment extends beyond 60 days from the date the claim was filed.
We will cooperate with your insurance company to assist with processing your claim. Please, do not submit additional claims or information to the insurance company unless specifically requested.
Emergency patients: Patients having emergency surgery must pay in full by credit card or cash for all charges before services rendered.
Minor patients: The parent or guardian accompanying a minor is responsible for payment of services. Regardless of insurance coverage, patients age 18 and older are responsible for payment unless a parent accompanies them to the initial appointment and sign s this agreement.
Divorce situation: The parent who brings the child to the initial appointments is responsible for all charges incurred during treatment, regardless of who provides insurance coverage. Our office will not become involved in payment disputes between divorced parents.
Returned checks: 30$ service will be charged for returned checks. Temporary or post -dated checks are not accepted.
Past due accounts: If your account becomes past due, we will take necessary steps to collect this debt. If we will have to refer your account to a collection agency or to a lawyer, you agree to pay all the collection costs, lawyer’s fees plus all court coats which are incurred.
Credit History: If you default on your account, we have the option to report your account status to any credit reporting agency such as a credit bureau. Waiver of confidentiality: You understand if this account is submitted to an attorney or collection agency, if we will have to litigate in court, or if your past due status is reported to a credit reporting agency, the fact that you received treatment at our office may become a manner of public record. Transfer of Records: You must make a request in writing to obtain copies of your records. Your request will be processed no earlier than five business days but no later than ten business days from the time we receive your request. You authorize us to include all relevant information, including your payment history. If you are requesting your records to be transferred from another doctor or organization to us, you authorize us to receive all relevant information including your payment history.
Effective Date: Once you have signed this agreement, you agree to all of the terms and conditions contained herein and the agreement will be in full force and effect.

Financial Options:

Dental financing

Take control health of your mouth. With the CareCredit
our special dental financing options.