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
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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