INSURANCE AND FINANCIAL POLICIES
Every effort is being made to keep down the cost of
dental care. You can help by making your payment at
the time of your visit. You will be given an estimate
of the approximate total fee at the beginning of any
necessary treatment and definite financial arrangements
will be made with you at that time.
Although we do request that services rendered on your
child’s FIRST visit be paid on the day of the
visit, several methods of payment are available after
that visit which we will be happy to discuss with you
on your fist visit to our office.  They
are as follows:
1. Payment
at time of visit is the customary method.
2. Mastercard,
Visa, or Discover
3. Insurance
– We will file insurance claims as a courtesy
to you at no charge. You must provide us with a current
insurance card that shows mailing address and telephone
number for benefit determination.
4. CareCredit
- CareCredit is a flexible patient payment program,
specifically designed for healthcare expenses, that
makes it easier for you to get the treatment or procedures
you want and need. CareCredit lets you begin your
treatment or procedure immediately—then pay
for it over time with low monthly payments that are
easy to fit into your monthly budget. Please visit
the website www.carecredit.com
or ask our front office staff for more information.
We file dental claims electronically within 24 hours of
service. If your insurance company will not accept e-claims,
we will file the claim on a standard insurance claim form.
It is your responsibility to provide
the office with the correct insurance information.
If benefits are to be assigned to our office, we must
have an Authorization/Release form on file that is signed
by the insured or responsible party. The office policy
regarding payments from your insurance company is that
we will file claims only twice for a specific claim
with a grace period of 30 days. If payment is not received
within 30 days, a statement will be sent to you requesting
payment in full and suggesting you contact your insurance
company.
Please remember that you are responsible
for payment of all fees to this office. Your dental
insurance plan is designed to share in the cost of your
dental treatment. It may not cover the total cost of
your treatment. Your insurance policy is a contract
between you and your insurance company. The insurance
company has no obligation to our office.
We are happy to cooperate with you and the insurance
company in order to help you receive the maximum benefits
available under your policy.
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Medical History, Treatment and Financial Consent
Form