In an effort to maintain treatment fees at a minimum while maintaining a high level of professional care, we have established the following financial policy for our office. Please feel free to discuss our fees with us at any time. Before any dental treatment is begun, the patient and/or responsible party will receive a consultation regarding treatment plan and cost.
We require payment in full for the portion, not covered by dental insurance, of dental services to be rendered. For procedures that take multiple appointments to complete, payment may be split up over the number of appointments required. Any other financial arrangements shall be made only at the finance manager and/or doctor's discretion. We accept cash, checks, Amex Visa, MasterCard, Discover, and upon request, we can also provide information regarding financial companies to help assist with the cost of your dental procedures such as Care Credit, and Citi Health. Credit applications for such financing options are available upon request.
As a courtesy to our patients with insurance, we will file your insurance claim, allowing you to pay only your deductible and/or estimated co-payment as services are rendered. Please remember that the contract is between you and your insurance company and your total balance in our office is always your responsibility. Please note that we allow 60 days for the dental claim to be paid. We make every effort to give you an accurate estimate of what your portion of our fees will be, based on the information provided to us. However, we have no way to guarantee the actual terms of your policy. If for any reason there is a balance remaining after your insurance company's payment, you will be sent the statement. Any dispute regarding reimbursement or the amount of reimbursement is between you and your insurance carrier. By agreeing to this policy you agree to all such conditions.
We schedule our appointments to provide each patient with our undivided attention. In order to accomplish this, please be advised that you will be charged for cancellations with less than 24 hours notice at the rate of $50.00 for examination/hygiene appointments and $75.00 for dental procedures appointments. Also, note that any type of deposits and/or payments towards the cosmetic cases will not be refunded. Should the patient change their mind for whatever reason during treatment, the patient will be responsible for all costs incurred including lab fees and related costs.
An account with an unpaid balance past 60 days will be sent to a collection agency. At that time, you will be responsible for any and all costs incurred in the collection of your debt from the last date of services, such as attorney fees, court fees and any other fees associated with the collection of your debt
Original records including radiographs are the property of this office. If you desire, we will provide you with a copy of your record or radiographs for a nominal duplication fee of $25.
We appreciate your confidence in choosing our practice. Please do not hesitate to inquire with a staff member should you have any questions regarding this policy.
I have read, understood, and agree to the Office Financial Policy stated above.