Richard L. Johnson, D.D.S.
Oral & Maxillofacial Surgery
FINANCIAL POLICY
Dear Patient,
Thank you for choosing us as your health care provider. The following information is a description of our financial policy:
Payments for services are due at the time of services rendered.
- We accept cash, checks, CareCredit, and most debit/credit cards.
- We will be happy to assist you with applying for financing should you so desire.
- We reserve the right to collect before services are rendered.
- It is our policy to collect 100% payment at the time of service, unless you have dental coverage.
{All charges will be discussed with you after the initial exam. You will have the opportunity to accept or deny treatment, and/or make any financial arrangements necessary}
All charges are your responsibility whether your insurance company pays or not.
- Not all services are a covered benefit. Benefits vary depending on your policy and insurance provider.
- It is your responsibility to verify your insurance coverage.
- Fees for non-covered services, deductibles, and co-payments are DUE at the time of treatment.
- If your insurance company does not pay your claim within a reasonable time frame, it is our policy to have you do any follow up with your insurance company and/or pay the balance due.
- We file your insurance as a courtesy to you but ultimately you are responsible for any and all charges incurred at the time of service.
- Insurance companies do not provide us with complete access of payment rules; therefore any quote of out-of pocket fees you are presented with today, is ONLY an estimate.
Again, thank you for selecting us as your health care provider. We appreciate your trust in us, and we appreciate the opportunity to serve you.
I have read and understand the financial policy. I also understand all charges incurred in this office are my responsibility. If an unpaid balance on my account is sent to a 3rd party collection agency, I give my permission to add any/all legal and collections fees to my account balance.
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