Financial Policy

Thank you for choosing our practice for your dental health care. Your clear understanding of our Financial Policy is important to our professional relationship. If you have any questions about our fees, our policies or your financial responsibilities, please do not hesitate to contact us. Please take time now to carefully review the following information and acknowledge when presented prior to treatment.

We require that all patients complete our Financial Policy prior to seeing the doctor or hygienist and upon each annual visit thereafter. It is your responsibility to notify our office of any patient information changes (name, address, insurance plan information, etc.).

Self-Pay Patients:

• Self-pay means patients with no insurance and patients who have an insurance plan with which we do not participate.
• Payment is required at the time of service and will be collected at check-in or check-out.
• We accept most major credit cards, checks and cash.
• We will always provide you with a receipt for treatment performed.
• We offer an in-house discount plan, which may provide superior value compared to traditional dental insurance.
• We will also help you to arrange for convenient financing from Sunbit and CareCredit ; please contact our office for additional information on these payment programs. 
  

Patients with Insurance:

• We participate in most insurance plans, including Medicaid.
• It is the patient’s responsibility to provide our office with current insurance information. We will ask for your insurance card at your first visit and will copy for our records. Please be prepared to show your current insurance card at each appointment. If current information is not obtained at the time of service, it will become the patient’s responsibility to pay the entire balance until current information is provided to our office.
• Please be aware that some services might not be covered by your health insurance plan. Some, or even all, of the services you receive may be non-covered or considered unnecessary by the insurer. It is very important to verify your coverage with your insurance provider, as non-covered services must be paid for in full at the time of the service.
• Your insurance policy is a contract between you and your insurance company. As a courtesy, and pursuant to contractual obligations, we will submit claims for you. However, we will not become involved in disputes between you and your insurance carrier. Such disputes include, but are not limited to, deductibles, co-payments, non-covered charges and “usual and customary” charges. We will provide clinical information as necessary.
• An estimate of treatment costs, including expected insurance contribution (if any), will be provided to you prior to treatment. The portion of the total cost expected to be payable by you will be due in full at the time of service (less any approved financing amounts).
• If your insurance company denies or fails to pay your claim (or any portion thereof) within 45 days, your claim balance will automatically be billed to you. You are ultimately responsible for the full payment of your account. 
  

Deductibles, Copays and Coinsurance:

• Deductibles, copays and coinsurance are determined by your insurance plan, not us.
• Deductible balances must be paid at the time of service.
• Copay amounts must be paid at the time of service.
• Estimated coinsurance amounts must be paid at the time of service.
• Any remaining account balances, including expected insurance contributions that are denied by your insurer, are your responsibility and will be billed to you after your insurance carrier has processed the claim.
• Ask us about financing plans to help with your copay and coinsurance portions.

Missed Appointments:

• Please help us serve you and others better by keeping your scheduled appointments.
• In the event you are unable to keep your appointment, please contact us at least 48-hours before your scheduled appointment time.
• Failure to provide at least 24 hours advance notice will result in a no-show charge of $25-$50. This charge is the responsibility of the patient and is not covered by insurance. 

Unpaid/Outstanding Balances: 

• The patient's expected portion of treatment costs is generally due in full at the time of service; this is subject to insurance verification and/or approved financing arrangements (for example, Sunbit, CareCredit or other approved payment plan).
• If your insurance company has not paid your claim balance in full, you will receive a statement notifying you of the amount due. Overdue balances will be considered for further collection activity. In the event your account becomes delinquent (90 days past due), we may refer the outstanding balance to a third-party collection agency, and you agree to reimburse us the fees of such agency (typically 30% of the referred balance) and any and all other costs, including reasonable attorneys’ fees, incurred in the collection of the outstanding balance.
• Failure to pay on a timely basis may result in you being discharged from this practice. If this is to occur, you will be notified by regular and certified mail that you have 30 days to find alternative dental care. During that 30-day period, our provider staff will only be able to treat you on an emergency basis.

Returned Payments (NSF):

• The charge for a returned check or rejection of bank draft is $35 and is payable by cash or credit card (no checks accepted for payment of NSF fees).
• This amount will be applied to your account in addition to the insufficient funds amount.
  

Credit Balances:

• From time to time, you could accrue a credit balance on your account. If your account reflects a credit balance, our policy is to carry the balance on the account until your next appointment or your transfer from the organization.
• You may request a refund of a credit balance at any time. Please allow ample time for review of your account and processing through our accounting department.

If you have any questions regarding this Financial Policy, please ask or call us BEFORE you are seen for treatment.

Thank you for understanding our financial policy, and thanks again for trusting us with your dental health care.