Cash/Credit or Debit Card:

 At the time you receive our service, you are responsible for all co-pays, deductibles and all "estimated" fees. There will be a 3.75% processing fee on all card transactions.

 Care Credit: 

OAC we offer up to 12 months no interest over $1000.00 and 6 months no interest below $1000.00 with a minimum of $300.00. Speak to our front office for details.

Insurance Accounts:  

We are pleased if you have dental insurance. However, our primary role is to provide excellent dental care and our relationship with our patients directly.  As a courtesy, we will submit your insurance claim for care you receive at our practice.  Any issues with your insurance after the claim is submitted that does not meet your expectations will be between you and your insurance company to resolve.  We will assist with this process as much as possible.  Not all services are covered in all contracts.  Some insurance companies arbitrarily select certain services they will not cover. You need to understand the scope and limitations of your policy, and that you are responsible for coverage of any service not covered by your insurance.

 

      ·  At the time you receive our service, you are responsible for all copays, deductibles, and all “estimated” fees             for items not covered by your plan.


      ·  You will need to provide accurate insurance and employment information. If inaccurate information delays a             claim, it can result in additional costs and inconvenience to you. 

      ·  If your insurance company does not process our correct claim within 60 days of the date of service, the                   entire  balance may be due to you. You can be reimbursed directly from your insurance company

         or you will be reimbursed by our office for any overpayments. 

 

In the event an account is not paid and we refer the account to collections, you will be responsible for all fees incurred for the collection of your bill, including but not limited to attorney fees, court costs, collection agency fees, and late fees on your unpaid balance. In addition, you will be seen by our office on a “cash only” basis or may be dismissed by our office.

 
All NSF checks will result in the balance due in full within five days with all applicable bank fees. If not paid within five days, the account will be sent to collections.


When you schedule an appointment, we reserve that time and prepare in anticipation of serving you.  In fairness to other patients, and the office staff, we require a 24-hour cancellation notice. Any short notice cancellations or missed appointments will be charged $50.00. We understand that conflicts arise; however, failing your appointment or canceling without adequate notice more than once will result in a charge.

Patients who continue to no-show and/or cancel without notice may be dismissed from the practice and asked to find another dentist. Any patient who is more than 10 minutes late may be considered a “no show” for their appointment and may need to be rescheduled.

As with any dental treatment, there may be unforeseen treatment adjustments and/or complications. The clinic will try to anticipate any changes in the treatment plan and advise you 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.


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.