Thank you for choosing our office for your dental care. We are committed to the success of your treatment. The following is a statement of our financial policy that we ask you to read and sign prior to any treatment. To accommodate you, we accept cash, checks, Visa, MasterCard and Carecredit. Payment is due at time of service unless we are submitting to your insurance.
We will accept assignment of your insurance benefits. The balance is your responsibility whether your insurance company pays for your treatment or not. We will gladly process your claims, provided that you give us accurate insurance information. It is your responsibility to inform us of changes in your insurance coverage. Your insurance policy is a contract between you and your insurance company. We are not a party to the contract. Please be aware that some, and perhaps all, of the services provided may be non-covered services and/or not considered reasonable or necessary under your policy. Regarding insurance plans where we are a participating provider, we will accept the “allowed amount” as it is stipulated in our contract with the insurance company. However, if a service is not covered, then it is your financial responsibility.
Our policy is to charge for missed appointments. Please help us serve you and our other patients better by keeping scheduled appointments. Appointments that are missed or changed at the last minute are then unavailable to patients who need appointments. Please consider your schedule carefully when making appointments. We will send a courtesy reminder one week ahead of your appointment that you are asked to confirm. We require a minimum of a 48 hour notice to change or cancel your appointment without a cancellation fee, Fridays, Holidays, and weekends excluded.
*Arriving late may require a second appointment to complete your cleaning
*A broken Hygiene visit will result in a $50.00 charge.
*A broken Doctor visit will result in a $100.00 charge.
Thank you for taking the time to read and understand our financial policy. Our practice is committed to providing the best treatment for our patients. Please let us know if you have any questions, Helen will be glad to review the financial policy with you at any time.