Our doctors are committed to providing exceptional dentistry to our patients. Although finances and benefits may be a factor in acceptance of treatment recommendations, our recommendations will be based on your dental needs and what is best for your oral health first.

 

INSURANCE:

Our office will do our best to help you understand your dental policy and maximize your dental benefits. However, every insurance policy is different. We can only estimate your coverage but cannot guarantee any coverage. We must emphasize that as dental care providers, our relationship is with you, not with your insurance company.  We encourage you to read your insurance policy so you are aware of the benefits and limitations of your specific plan, as not all services are a covered benefit and you are ultimately responsible for understanding your plan.

Filing of claims is done as a courtesy to our patients. Most claims process within 30 days of submission. We require any outstanding balance not covered by insurance be paid within 30 days of receiving the insurance payment.  Any outstanding balance older than 60 days will be followed up with phone calls and letters, unless prior arrangements have been made. If payment is not received within 120 days, accounts may be filed with Small Claims Court and you will be dismissed from our practice.

PRETREATMENT ESTIMATES WILL BE FILED UPON REQUEST.  Pretreatment Estimates allow you to see how your insurance will process treatment before it is performed. This will allow you to better know what your out-of-pocket expense may be before your appointment.  Please remember this is only an estimate. Outstanding claims, pending claims, or a policy change could affect this estimate. Our office is happy to review your pretreatment estimate with you once you receive it in the mail.  

SELF PAY:

Payment is due in full upon receipt of your first account statement unless prior financial arrangements have been made. Financial options available are as follows:

1.      5% discount for accounts paid in full on same day of service with cash or check only.

2.      We accept Visa, Mastercard, or Discover cards. 

3.      For multistage treatment plans, 50% down payment is required with the remaining 50% due before the next stage of treatment.  


ACKOWLEDGEMENT

 I understand payment is due in full upon receipt of my first account statement unless payment arrangements have been made. If no insurance is being filed, payment in full with cash or check on date of service will result in a 5% discount. Mastercard, Visa, and Discover are accepted but no discount will be available. I understand that any outstanding payment over 60 days will result in phone calls and letters from our office. If the balance is not paid within 120 days, my account could be sent to Small Claims Court and result in dismissal from this practice. 

I understand that if I have questions or concerns, I need to follow up with the billing department at Lancaster Dental Associates (608-723-1162) or with my insurance company directly. 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.