Financial Policy

We are so pleased that you have chosen our practice to take care of your medical needs. We make every effort to deliver the finest care at the most reasonable cost to our patients. It is very important to us that we earn your trust.

In order to build a successful physician-patient relationship with you and your family, your clear understanding of our Patient Financial Policy is important. As a part of a professional relationship, we kindly ask that you make your payment at the time service is rendered unless other arrangements have been made in advance prior to the procedure. For your convenience, we accept cash, checks, or credit cards.

We know that the cost of care can be confusing. We are happy to help you navigate your dental insurance and also give you an estimate of the charge for any procedure or surgery you may require ahead of time. 

Insurance Policy

Insurance is a contract between you, your employer and your insurance company. If you have any dental and/or medical insurance we will be glad to fill out the proper forms and submit your claims for you and will work hand in hand with you to maximize your insurance reimbursement for covered procedures. In order to properly bill your insurance company we require that you disclose all insurance information including primary and secondary insurances, as well as, any change of insurance information.

Although we may estimate what your insurance company may pay, it is the insurance company that makes the final determination of your eligibility and benefits. Pre-authorization provided by your insurance company does not constitute a guarantee of payment and if the insurance company should deem the services and deny payment after the services are have been rendered, the remaining balance will be patient’s responsibility.

If your insurance company is not contracted with us, you agree to pay any portion of the charges not covered by insurance. If we are out of network for your insurance company and your insurance pays you directly, we kindly ask you to forward the payment to us upon receipt.

Please remember that insurance is considered a method of reimbursing the patient for fees paid to the doctor and is not a substitute for payment. Some companies pay fixed allowances for certain procedures and others pay a percentage of the charge. It is ultimately your responsibility to pay any deductible amount, co-insurance or any other balance not paid for by your insurance company. 

Minors & Guarantors

All patients under the age of 18 years of age must be accompanied by a parent or guardian for all visits including surgery and post operative visits. Regardless of who is the policy holder for the insurance, the parent or guardian present will be responsible for any amount owed. Coordination of payments between divorced parents must be made prior to your visit.

Adult children (patients over the age of 18 and still on parent’s insurance) are responsible for all amount owed.

Worker’s Compensation & Automobile Accidents

In the case of a worker’s compensation injury or automobile accident, you must obtain the claim number, phone number, contact person, and name and address of the insurance carrier prior to your visit. If this information is not provided, you may be asked to either pay for your visit at the time of service or reschedule your appointment.

Returned Checks

The charge for a returned check is $25 payable by case or money order. This will be applied to your account in addition to the insufficient funds amount.

Outstanding Balance Policy

It is our office policy that all past due accounts be sent three notifications. Returned checks and balances older than 90 days may be subject to additional collection fees and interest charges of 1% per month or 12% annually.  If payment is not made on this account and no resolution can be made, the account will be sent to a collection agency. In the even an account is turned over for collections, the person financially responsible for the account will be responsible for all collection costs including attorney fees and court costs.

This financial policy helps the office provide quality care to our valued patients. If you have any questions or need clarification of any of the above policies, please feel free to contact us. 

Patient Financial Policy