FULL PAYMENT is due at the time of service. If insurance benefits apply, ESTIMATED PATIENT CO-PAYMENTS and DEDUCTIBLES are due at the time of service. Patients having the following procedures Implants, Biopsies and Wisdom teeth/Multiple extractions, are expected to pay 50% one week prior to surgery. For patients with no dental insurance 50% will be collected one week prior to surgery and the other 50% at the time of service. Payments may be made using cash, check, Visa, MasterCard, Discover and Amex. We also offer https://www.carecredit.com/, which is a financing option that is available only for healthcare expenses.
We will collect a nonrefundable deposit of $500 at the time of procedure scheduling. We require at least 24 hours’ notice to reschedule or to cancel an appointment. Cancellation or rescheduling of your appointment within 24 hours of surgery will result in forfeiture of the deposit and a new deposit may be required to reschedule.
As a courtesy to our insured patients, we submit claims to your insurance company for you. We will help you receive your maximum allowable benefits. In order to do this we need your insurance card and/or insurance policy with you at your first visit.
Any account resulting in a credit balance after insurance adjudication is reviewed by the treating practice will be refunded. All refunds will be made via check, refunds are processed every two weeks.
You must realize that:
All charges you incur are your responsibility regardless of your insurance coverage. Our relationship is with you the patient and not with the insurance company. Your insurance policy is a contract between you, your employer, and the insurance company. We are not a party to that contract.
If your insurance has not paid within 90 days of services rendered, you will need to make full payment to this office and be reimbursed when your insurance company pays. After 90 days the patient is responsible to pursue payment from the insurance company.
Please indicate your understanding and acceptance of these financial policies by signing below. For the mutual convenience of you and the practice, it is understood that this executed copy of the Financial Policy also shall cover your dependent children who are patients of the practice.
If payment is delinquent, the patient will be responsible for payment of collection, attorney’s fees, and court costs associated with the recovery of the monies due on the account.