Payment is expected at the time of service for any office procedure, including consultation and x-rays. For patients covered by a Medical/Dental insurance plan, we will assist you in filing your insurance forms. Most insurance companies will respond within four to six weeks. Please note that insurance rarely pays the entire treatment balance, even if your policy states “100% coverage”. All account balances are ultimately the responsibility of the patient or guardian. Patient, parent or guardian signature is required before treatment begins.
The experienced staff is here to assist our patients. We make every effort to provide you with the finest care, and the most convenient financial options. To accomplish this, we work hand-in-hand with you to maximize your insurance reimbursement for covered procedures.
If your account has a remaining balance it may be paid by cash, check, debit card, Visa, MasterCard, Discover, American Express, or CareCredit. You will receive a statement from our office, which is payable upon receipt. Overdue accounts will be sent to an independent collection agency and/or small claims court.
Any separated or divorced parent accompanying a dependent child for treatment will be considered to be the financially responsible guarantor.
I understand the payment policy and have read it in its entirety. I hereby authorize the release for pertinent medical information necessary for my treatment. I verify that the information I have provided is accurate.
Please remember, you are fully responsible for all fees charged by this office regardless of your insurance coverage.