1) We request payment for services at the time services are rendered. We accept
cash, checks, and credit cards.
2) For emergency visits, we require payment in full at the time of the appointment.
3) Insurance:
a. We are in network with mostinsurances. Please call the office
to obtain more information.
b. If you have insurance, as a courtesy to our patients, we gladly process your
claim. The ESTIMATED portion is required when services are
rendered. Any amount not covered by insurance or difference in the
estimatedportion is the patient’s responsibility. Our office will file your
insurance a maximum for two times per appointment. The office will
only file the PRIMARY insurance. We will gladly provide you with a
receipt so that you can file for the secondary insurance. The
reimbursement for the secondary insurance must be paid to the patient.
c. If the claim is not paid by your insurance carrier within 60 days, you will
be responsible for the full balance. Any further insurance appeal is the
patient’s responsibility. We will be happy to provide you with a claim
formso that you can follow up on your insurance claim on your own. Any
unpaid balance after 60 days will accrue a 1.5% finance charge until paid
infull.
d. Please provide the office with your dental insurance card with the proper mailing address for your insurance company. If you have not provided the needed information or enough time for us to acquire your insurance information, you may be responsible for all the fees for the services rendered.
e. Please note that you are responsible for any co-payments or deductibles at the time of service. You are also responsible for all charges not covered by your insurance company, including all fees considered above your insurance company’s usual and customary fee schedule. Your insurance benefits are a contract between you and your employer.
The amount of coverage you will receive depends on the quality of the
planpurchased by your employer, not the fees of the doctor.
4) The office cannot carry balances longer than 90 days, regardless if the insurance
payment is still pending. After 90 days, we will inform you of the delinquent
account by letter and if no action is taken to clear the account, the office will be
required to employ a collection service to collect payment. The responsible party
agrees to pay all reasonable, related collection fee.
5) There will be a $30.00 service charge for all returned checks.
6) The parent or guardian must bring the child to the first visit. The accompanying
parent/guardian is responsible for the payment. In case of a divorce, the
accompanying parent is responsible for the payment independent of what a
divorce decree may state. Reimbursement must be made between the divorced
parents. We will not intervene.
7) We reserve a time in our schedule especially for your child. We request at least a
24 hour notice prior to cancellation or rescheduling of the appointment so that
the appointment can be offered to another child. There will be a charge of $25
per child for NO SHOW appointments or cancellations with less than 24 hours
notice. If two broken/missed appointments occur or two cancellations without
24 hour prior notice, we reserve the right NOT to schedule any subsequent
appointments.
8) Please note, if patients are more than 15 minutes late to their appointment, the
appointment may have to be rescheduled as a consideration for other patients.
As always, we understand circumstances do arise. Please do not hesitate at any time to call our office to discuss any concerns. We are happy to help. Thank you for your consideration, and allowing to provide a happy, healthy smile for your child!