Harbour Place Dental

Dr. Kathryn Onishi

Financial Arrangements and Office Policy

For all patients:

Outstanding Patient Service is our Goal!

The goal of Harbour Place Dental and its staff is to make sure that you receive the highest quality dental care and service. One step is to make certain our financial policies are clear and understood by you.

If you have dental coverage:

We go the extra mile!

If you have dental insurance, we will make a good faith estimate of the amount your insurance carrier may pay based on the information provided by them, and will defer billing you for that amount for up to 60 days.You will be responsible for paying all charges at the time of service except the portion estimated by your insurance(co pay).We will file all dental claims on your behalf as well as provide any information required by your insurance carrier to ensure it is processed in a timely manner. We will also follow-up with your dental insurer when claims are not processed in a timely manner and attempt to expedite payment.

If your insurer denies coverage, or if we otherwise do not receive payment within 60 days from filing your claim, the amount will then become due and payable by you.Remember that your coverage is a contract between you and/ or your employer and your insurer.Although we make every effort to help you obtain your benefits, we cannot force your insurer to pay.

Your payment is due at the time of treatment. The amount estimated to be your portion of treatment costs is due at the time of treatment. We accept Cash, Check, Visa, MasterCard, American Express and Care Credit. We also offer a 1 year interest free payment plan for balances and treatment costs exceeding $500. Ask the front office for more details.

In addition, if you do not have dental insurance a 5% discount is available when you pay with cash or check at the time of service. We also offer a 5% senior discount if you do not have insurance and are over 65 years of age. These discounts do not apply if other discounts are extended.

Office Policy:

We understand that unforeseen circumstances can arise, therefore, we will not charge you for a cancelled appointment if we receive notice 2 “two” business days before the appointment, from you. That allows us the opportunity to give another patient this valuable time with one of our dental care providers.Any No Show or cancelled appointments without ample notice are subject to a $25.00 per half hour charge. No food or beverages are allowed in treatment area. Please be courteous to others and TURN OFF CELLULAR PHONES, to ensure a calm and comfortable environment for our patients.

Patient’s Signature: ______Date: ___/___/___