Office Financial Policy

I understand that my dentist and staff will estimate insurance as close as possible. I understand that I am responsible for the payment of the account and providing correct insurance information.

I understand that if insurance is not applicable when dental services are rendered; my full payment is due at the time of service.

I AM RESPONSIBLE FOR MY BALANCE IF ANY OF THE FOLLOWING OCCURS:

A.     Treatment goes over my maximum benefits.

B.     Insurance benefits have been utilized elsewhere.

C.     I am not eligible for insurance when services are rendered.

D.     I prevent or delay the payment by not complying with requests for insurance forms or signatures.

E.       I do not complete my treatment and it results in non-payment by the insurance company.

F.       Lab costs are incurred due to missing appointments.

G.     Lab modifications.

H.      I receive my insurance check and do not send it to your office.

I have read and understand my obligations in acceptance of my dental insurance as payment.

*Please note: A credit card processing fee of 3% will be applied to all payments made by credit card. This reflects the cost incurred by our office to process credit card transactions. You may avoid this fee by choosing to pay with debit, cash, or check.