PAYMENT:

1. Payment is expected in full on the day of service unless prior arrangements have been made with the doctor and the billing receptionist.

2. If you have no dental insurance coverage and either self-pay or are reimbursed through a Healthcare Savings Account, payment in full is expected on the day of service.  A detailed receipt will be provided to you upon request.

3. The parent or guardian who accompanies the child to their dental appointments is considered the responsible party and fully responsible for any payment due regardless of living, marital, or court designated status.  No exceptions will be made to the policy.

4. For your convenience, we accept payment by Visa, MasterCard, Discover, personal check, cash, or money order.

5. For any balance remaining on your account, the responsible party will be billed.  All accounts past due 60 days will receive a $20 billing fee.

6. All accounts past due 90 days will be sent to an outside collection agency.  Once an account has been placed for collection, any future payments must be paid in cash only.  You also agree to reimburse us the fees of any collection agency, which may be based on a percentage at a maximum of 33% of the debt, and all costs, and expenses, including reasonable attorney’s fees, we incur in such collection efforts.  The account MUST be paid in full prior to delivery of further treatment.

7. A fee of $40.00 will be added to your account for any returned check.  The fee, plus full payment for the check that did not clear, must be paid in cash, Visa, MasterCard, Discover, or money order within 10 business days of our bank notification.
 

INSURANCE:

1. It is your responsibility to keep the practice updated with your most current information (insurance, address, phone numbers. Etc.) If you move or if you temporarily relocate for more than one month, please notify our office.

2. Although we will file insurance claims for you as a courtesy, your dental insurance policy is a contract between you and your insurance company.  We are not a party to the contract. (With exception of Excellus, Met Life, United Concordia, Delta Dental, Cigna).

3. If you have dental insurance that reimburses you directly, you will be expected to pay for the treatment in full at the time of service.

4. Your claim will be filed immediately, and benefits are expected to be paid within 30 days.  If any problems arise that cause your account to go overdue 30 days without insurance payment (ex. premiums not paid, identification numbers not correct) the balance will become your responsibility.  You are responsible for any amounts your insurance company chooses not to pay, for whatever reason.  Further, it is your responsibility to contact your insurance carrier directly to dispute or question any payment or non- payments made.  Please be aware that some, and perhaps all of the services provided may be non-covered services and not considered reasonable and customary under the terms off your insurance policy.  Our practice is committed to providing the best treatment for our patients and treatment is not determined based on what insurance companies arbitrarily regard as usual and customary rates.

5. We will do our best to give you an estimate of the balance due for each upcoming visit, based on your individual treatment plan.  Full balance payment is expected at the time of treatment.


APPOINTMENTS

1. 24 hour notification is required for all cancellations.

2. After two (2) broken appointments or failure to reschedule an appointment with adequate notice (24 hours) a $50 fee will be assessed to your account.  Please understand this minimum charge covers only a portion of the office overhead.