Payment and Dental Insurance Information

Dear Patient:

Thank you for choosing our office for your dental needs. We are committed to providing you with excellent care and believe successful financial arrangements are part of successful, predictable treatment results. We strive to provide open and honest discussion of recommended treatment options in a comfortable, friendly, and compassionate atmosphere.

♦A Note on Minor Patients: The adult accompanying the minor is responsible for the payment on the account. For unaccompanied minors, non-emergency treatment will be denied unless payment is prearranged.

Payment is due at the time treatment is rendered. We accept cash, personal checks, all major credit or debit cards. However we know it is not always possible to pay your dental bill in full, we would like to explain our financial guidelines. Please choose the option that works best for you.

Dental Insurance: If you have dental insurance, we will complete your insurance form with all the necessary information and submit it to the insurance company as a service to you. We ask that you pay the estimated co-payment at the time services are rendered. If you fail to bring the required insurance information to your appointments we will ask that you pay the bill in full and obtain reimbursement directly from your insurance company with paperwork provided by our office.

♦Our office does not guarantee that your insurance company will pay for the treatment you receive from our practice. If your claim is denied or the treatment is down-coded and or alternative benefits are paid, you will be responsible for paying the full balance on the account at that time.

♦Our office will not enter into a dispute with your insurance company over any claim, although we will provide the necessary documentation your insurance company requests to settle the claim.

♦If your insurance company has not made a payment within 30 days of billing, the balance will become your responsibility. (Insurance coverage is a contractual agreement between the insurance company and you or your employer. We have no control over this relationship).