We welcome you to our office. We are committed to your treatment being successful. Please understand that payment of your bill is part of your treatment. The following is a statement of our financial policy, which we require you to read and sign prior to any treatment.

Payment is expected as services are rendered. If you are covered by dental insurance, we expect payment for deductibles and co-payments on the date of service. For your convenience we accept Cash, Check, Visa, MasterCard, American Express, Discover and CareCredit.

Regarding Insurance

We are happy to extend the courtesy of billing your insurance company for you. However, in order to provide this service to you, we must have COMPLETE insurance information and confirmation of your coverage. It is your responsibility to fill out the necessary forms that give us all the insurance information required. If this information is not provided to us in a timely manner, we will be unable to bill your insurance company for you and you will be expected to pay in full for services rendered. If we have not received payment from your insurance company within 45 days of billing, the balance is due and payable by you, the patient. Your insurance is a contract between you and your insurance company and we are not a party to that contract. You will be expected to contact them directly if a problem should arise. We expect all balances to be cleared in less than 60 days.

We do NOT accept or file with Medicare, Medicaid, and/or any medical insurances.

Usual and Customary Rates

Our practice is committed to providing the best treatment and we charge what is usual and customary for our area. You are responsible for payment regardless of any insurance company’s arbitrary determination of usual and customary rates. Please keep in mind that we can only ESTIMATE what your insurance will pay since each insurance company has their specific limitation and exclusions.

Billing

For all accounts over 60 days with patient amounts due, there will be a finance charge of 1.5%
per month.

All returned checks will be subject to a $25.00 returned check fee.

All accounts over 120 days will be assigned to a collection service for processing. Should this situation arise, you agree to pay any reasonable additional fees, including any and all collection agency, legal fees and/or court costs, necessary to collect this account.

CareCredit

We offer and accept payment plans through CareCredit. CareCredit is a personal line of credit for healthcare procedures that can be used for your entire family.

Advantages: CareCredit works like a credit card but it has two advantages. It can only be used for healthcare services and you can get NO INTEREST financing every time you use it.

Simply pay your minimum monthly payment and pay off the entire balance by the end of your promotional period and you pay No Interest. If you need more time to pay for your procedure, you may be eligible for extended payment plans with low, fixed interest rates.

For more information on CareCredit please visit www.carecredit.com