 Appointments
Your scheduled appointment time has been reserved specifically for you. We request 24-hours notice if you need to cancel your appointment. We are aware that unforeseen events sometimes require missing an appointment.
Insurance
We offer the courtesy of filing your dental insurance. We accept most PPO insurance plans and are an in-network provider with Delta Dental Premier. Our office is committed to helping you maximize your insurance benefits. Because insurance policies vary, we can only estimate your coverage in good faith but cannot guarantee coverage due to the complexities of insurance contracts. Your estimated patient portion must be paid at the time of service. As a service to our patients, we will bill insurance companies for services and allow them 45 days to render payment. After 60 days, you are responsible for the entire balance, paid-in-full. If you have any questions, our courteous staff is always available to answer them.
Financial Information
Payment: Payment is expected in full for each appointment as services are
rendered. Payment options are:
-
Cash
-
Check
-
Credit Card (MasterCard, Visa, American
Express and Discover
-
Care Credit (Special financing on
approved credit offering no interest
plans)
Dental Insurance:
Patients must realize that
professional services are rendered to a
person, not to an insurance company.
Hence, the insurance company is
responsible to the patient and the
patient is responsible to us. We cannot
render services on the assumption that
the charges will be paid by an insurance
company. We will file your primary
dental insurance claims as a
courtesy to you. To avoid
disappointment, we strongly suggest that
patients contact their insurance company
to make certain their dental insurance
assumptions are correct. Most insurance
companies only pay a portion of the
dental investment. You agree to pay any
portion of the charges not covered by
your insurance. We will file a
pre-determination for recommended
treatment when it is requested by you.
If your insurance company requires a
referral, you are responsible for
obtaining it.
Emergency/After Hours
Appointment: If your child
is seen for an emergency visit after our
regular business hours, an “after hours”
fee is charged in addition to any
treatment on that visit. All emergency
treatment must be paid in full at the
time of service.
Finance Charge:
A finance charge will be added
to your account for any balances over
$50.00 that is unpaid within (30) days
of the date of service. The FINANCE
CHARGE will be computed at the rate of
(1.5%) per month.
Returned Checks:
There is a fee ($30.00) for any
checks returned by the bank.
Monthly Statement:
If you have a balance on your
account, we will send you a monthly
statement. It will show the previous
balance, any new charges to the account,
finance charge, if any and any payments
or credits applied to your account
during the month. Professional fees are
the responsibility of the parent or
guardian authorizing treatment; we
cannot send statements to other persons.
Past Due Accounts:
If your account becomes past
due, we will take necessary steps to
collect this debt. If we have to refer
your account to a collection agency, you
agree to pay all of the collections
costs which are incurred.
Divorce:
In case of divorce or separation, the
responsible party prior to the divorce
or separation remains responsible for
the account. If the divorce decree
requires the other parent to pay all or
part of the treatment costs, it is the
authorizing parent’s responsibility to
collect from the other parent.
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.
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