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Forms & Financial Information
 USEFUL FORMS :
FINACIAL INFORMATION :
We appreciate you allowing us to provide dental care for your child. We wish to attract parents to our practice that take an active role in their child’s dental health and remain financially responsible. Because we value our relationship with you and believe that the best relationships are based upon understanding, we offer these clarifications on methods of payment & insurance reimbursement.
Payment Policy
Payment for professional services is due at the time dental treatment is rendered. Every effort will be made to provide a treatment plan which fits your timetable and budget. For your convenience, we offer the following methods of payment: Cash, Debit Cards, and most major Credit Cards.
Dental Insurance
We are dedicated to providing all our patients with the finest treatment available and base our treatment recommendations on what will be best for your child and not what your insurance company does or doesn’t pay.
Please note the following in regards to your dental insurance coverage:
- We must emphasize that as a health care provider, our relationship is with you and your child, not your dental insurance company. Your dental insurance is a contract between your employer and the insurance company. Most plans routinely pay between 50-80% of the average total fee for a covered treatment.
- As a courtesy, we will be happy to file for your insurance benefits, though we are not obligated to do so. Because your dental insurance plan is a contract between you, your employer and the insurance company, many carriers will not reimburse this office. In this instance, you will be responsible for the full cost of the visits at the time services are provided and your insurance company will send you the reimbursement check directly.
- Any amount determined to not be covered by your insurance company is payable at the time services are rendered; these fees may include deductibles, co-payments, or certain procedures that are not covered by your insurance policy. Unfortunately, some of the services that we may recommend for your child will not be covered by your specific dental policy. Our primary goal is to treat your child using the best possible materials, supplies, and medications within a safe and non-threatening environment and not necessarily in the cheapest manner, which can be the goal of insurance companies.
- We allow a maximum of 45 days for your insurance company to clear account balances. Any unpaid portions will be due in full, by you, after this period.
- Our office does not determine your dental benefits. Your employer chooses a particular policy and if you are unhappy with it’s specific coverage, this should be brought to your supervisor’s attention. Only your employer can adjust benefits or change policies.
Financing Programs
To help provide cost-effective care to our patients, we work with several healthcare lenders to offer short & long term financing programs for dental treatment. Please feel free to inquire about these various payment programs.
Financial Obligation
After attempts to collect outstanding funds and a 90 day grace period from time of service, parents/guardians not fulfilling their financial obligation will be sent to collections, as stipulated by our accountants.
Prior to completing any treatment, we will provide you with a cost estimate indicating our total fee, what we anticipate your insurance coverage to be, and your estimated out-of-pocket portion. Please remember that this is only an estimate based upon generalized information provided by your dental insurance company. Any additional billing or possibly a refund may be subsequently required, should information provided be inaccurate.
We will always do our best to maximize the insurance benefits that you are eligible to receive and we appreciate your prompt settlement of any charges that may be incurred during your child’s treatment process. We look forward to years of close association with you, as we work together to care for your child’s oral health! |
