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Payment/Insurance

 

  Payment:

Credit Card - We accept  Visa, MasterCard, American Express and Discover.

Care Credit Medical/Dental Card - This card allows you to take up to 1 year, interest free, to pay the balance. You can apply in our office.

Cash or Personal Check

 

Visa MasterCard Discover Care Credit
       

 

PAYMENT/INSURANCE AGREEMENT:

     We, the Doctors and Staff, welcome you to our office.  We want you to be comfortable and satisfied with our office and services and if there is anything we need to do to make it so, we will welcome your input.  

The following are a few of our office policies that we feel need to be mentioned: 

            Our office schedule is designed to allow us to operate at maximum efficiency while keeping your wait to a minimum, preferably with no wait at all.  The worst disruption to the schedule comes when a patient fails to show up for their appointment.

  As we try not to over book our schedule, this “NO SHOW” literally leaves us with nothing to do.  Therefore, there will be a fee of up to $40.00.

 We also request, for the same reasons mentioned above, a 24-hours notice to cancel an appointment.  There will be a charge for appointments cancelled without 24-hours notice

Please remember the appointment time is reserved for you. We will attempt to remind you of your reservation by calling the phone numbers you provide.  We do this as a courtesy and we will make every effort to confirm the appointment.  However, it is the patients’ responsibility to keep the appointment even if we are unable to contact you.

 Payments are due in full on the day of service.  We offer several payment methods such as cash, local personal checks, most major credit cards and extended payment plans.  Arrangements for extended payment plans must be made before any service will be started.  There is a fee of $35.00 for all returned checks. NSF checks will be sought after to the full extent of the law.

             It is the patients’ responsibility for any unpaid balances regardless of your insurance coverage.  Insurance companies are numerous with varied benefits and various levels of coverage.   Your policy is a contract between you and your insurance company.  We will attempt to estimate your portion (co-payment) but please remember that this is only an estimate and the actual amount will vary depending on your deductible being met and whether your insurer accepts our fees as “Usual and Customary (UCR)”.  Remember, it is your insurer who decides what the “Usual and Customary” fee is and it is in their best interest to keep the UCR low. 

Our office will almost always do a metal-free, tooth-colored filling (resin). Most insurance companies will only pay for the lesser metal fillings (amalgam). If you would like a metal filling, please tell us each time before we do our procedure.  The difference in cost between these filling materials can range from $10 to $30 and we will either collect the difference at the time of service or after your insurance has paid.

 If you have multiple plans, we will file them all for you as a courtesy, but payment will be expected at the time of service based on your PRIMARY PLAN benefits.  Any credit due you will be issued promptly at your request once secondary claim has cleared.

If you have a DISCOUNTED FEE PLAN, payment in full is due the day services are rendered, otherwise you will be charged and responsible for the full fee.   

            If your coverage lapses or if you no longer participate as a member of a plan, you will be charged our regular fees. If after all claims are paid and there is a balance or if there is a balance for any other reason, you will have 30 days to pay the amount due.  If your account is not paid in the allotted time, it will be turned over to our Collection Agency.  Please note that in addition to your balance, any fees associated with collecting your balance will be your responsibility.

 







 

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