Payment & Account Balances
All patient balances are due immediately after treatment is rendered. Please ask us if you are interested in learning about third‑party financing, which may allow you to finance your treatment in low monthly payments.
Should a balance accrue on the account, the following process will be followed:
At Time of Service (initial): An invoice will be provided at checkout.
30 Days Past Due: A statement will be mailed to the address on file.
60 Days Past Due: A statement will be mailed, and will attempt to contact you by phone/text.
90 Days Past Due: A final statement will be mailed, and will attempt to contact you by phone/text.
120 Days Past Due: A letter will be sent notifying you that the account will be referred to collections in 15 business days unless paid in full.
Interest may be applied to the account during this process.
Services may be paused for accounts in collections until balances are resolved.
A returned check fee may also be applied and must be payable from you for each check payment returned to us by your bank.
Insurance
Dental insurance is a contract between the patient, their employer (if applicable), and the insurance provider. Submitting claims for payment to the insurance provider is a courtesy provided by the dentist, not an obligation.
I understand that I am ultimately responsible for any treatment that is unpaid by my insurance provider.
If there is dental insurance on the account, the clinic has established the patient balance based on the information I have provided. Final treatment payment is subject to the terms and conditions of my insurance provider on the date of service. Until payment is received from my insurance provider, no patient payment is final.
Predeterminations from my insurance provider(s) are NOT a guarantee of payment.
Estimates do not take into consideration any money that was billed toward my financial maximum or treatment limits that may have been used at other dental clinics.
For patients with secondary dental insurance, claims will be submitted as a courtesy. Payments received from secondary insurance after the primary insurance has paid in full will be applied as an insurance overpayment and may be allocated toward written-off charges, non-covered services, or remaining account balances.
Treatment Estimates & Adjustments
Estimates and treatment plans are based upon information gained from the examination. As with any dental treatment, there may be unforeseen treatment adjustments and/or complications.
The clinic will make an effort to anticipate any changes in the treatment plan and advise me at that time. However, such events are unpredictable.
Likewise, the timing or spacing of appointments may need to be modified as needed to accomplish the best result possible.
Deposits, Cancellations & No‑Show Fees
For appointments longer than 2 hours, a $250 deposit will be collected at the time of booking.
This deposit will be applied toward the total cost of treatment.
If the appointment is canceled more than 24 hours in advance, the deposit will remain as a credit on the patient’s account.
If the appointment is canceled within 24 hours of the scheduled time and is not rebooked for the same day, the deposit will be non‑refundable.
A $50 non‑refundable cancellation/no‑show fee will be charged for any appointments canceled within 24 hours of the scheduled time or missed without notices.
Implant Cases
For all implant cases, a deposit will be required. The deposit is determined case by case.
The deposit will be due at time the treatment plan is accepted.
I have read, understand, and agree to the above financial policy for payment of professional fees. I understand that I am ultimately responsible for all fees for services rendered to me and/or my family.