Insurance Consent for Estimates and Treatment

If you have dental insurance, it is your responsibility to bring your plan information with you to present at the time of service. We will file insurance claims as a courtesy to our patient. Remember that your insurance contract is between you and your insurer. It is your responsibility to be aware of insurance available for each treatment, any specific clauses stated in your policy, and deductibles and waiting periods. Insured patients should be prepared to pay their co-pay and/or deductible at time of service.

If your insurance company pays only part of your bill or rejects your claim, you are financially responsible for the balance and the balance will be due upon receipt of your statement.

It is also your responsibility to make sure that we are a listed provider with your insurance company.  We will do our utmost to help you understand your insurance benefits and file your claims for you; however, any assistance in these matters provided by the dentist and/or staff is strictly a courtesy and implies no responsibility on their part for filing, follow-through, or confirmation of coverage.

I understand and agree that the payment of my bill is my obligation, regardless of how much my insurance covers. All filings of insurance papers, confirmation of insurance coverage, and/or payments are my responsibility.