It is your responsibility to keep all appointments. If you cannot keep your scheduled appointment time, in consideration of other patients in need of treatment, we kindly ask that you give the office a 24 hour advance notice, so that we may offer your reserved time to another patient who is in need of our care. If I am more than 15 minutes late for my cleaning appointment, I will either take my remaining time only or reschedule.
Payments are due at the time of visit. This includes all Co-pay’s, co-insurance, and deductible amounts, for your convenience we accept Cash, Check, Visa, and MasterCard.
Return checks “any bad check can and will be turned over to the justice of the peace if the account is not reconciled within 20 days.” You will also be responsible for a returned check fee in the amount of $25.
If a minor is brought in for treatment, the adult seeking the treatment is responsible for payment, regardless of who carries the insurance policy or who has custody.
Professional courtesies are between dentists. I agree not to requests records until I have a new dentist.
We participate in several dental plans. It is your responsibility to verify that we do participate on your plan. It is also your responsibility to know the terms, limitations, and benefits of your plan.
If we file insurance on your behalf, we need a copy of your current insurance card; you are required by your insurance company to pay all co- pay’s, coinsurance, and deductibles which are due and payable at the time of service.
Verification of your insurance does not guarantee payment. Payment is subject to review by your insurance company. Payment is determined upon the actual receipt of the claims by the insurance company. If your insurance denies payment for services, you will be billed and it is your responsibility to pay for the service within 45 days of the date of treatment. It is your responsibility to contact your insurance company to dispute any denial, or nonpayment issues.
We will be happy to assist you in preparing forms or printing receipts for you to file with your insurance company.