Dental Insurance Information
FINANCIAL & CANCELLATION AGREEMENT
IF YOU HAVE DENTAL INSURANCE:
Your insurance is a benefit to you. As a courtesy, our staff will coordinate your dental benefits and send claim forms along with any required correspondence to your insurance carrier. The information our staff receives from your insurance carrier regarding your dental benefits is an estimate and is not guaranteed until it has been reviewed and authorized by a professional representative from your insurance carrier. Services not covered by your insurance carrier due to waiting periods, or any other reason(s) specified by your insurance carrier, are YOUR RESPONSIBILITY and are to be paid IN FULL at the time services are rendered, or upon rejection of your claim.
Dental benefits are based upon a contract made between you and your insurance company. If you have any questions regarding your dental benefits please contact your insurance company directly. Dental benefit plans will NEVER pay for all dental care expenses. It is only meant to assist you.
WE DO NOT ACCEPT SECONDARY INSURANCE due to numerous limitations placed by insurance carriers regarding coordination of benefits and several policies. Your portion is due regardless of the secondary coverage. You are responsible for submitting any claims and necessary correspondence to your secondary insurance carrier for reimbursement.
IF YOU DO NOT HAVE DENTAL INSURANCE:
Payment is due in full at the time services are rendered. Our office accepts Visa, MasterCard, Discover, American Express, Care Credit, Debit cards, Cash and Personal checks.
CANCELLING AND RESCHEDULING PATIENTS
Broken appointments are a significant contributor to rising healthcare costs, and we make every attempt to remind you of your upcoming appointments by E-mail, Text message, and Telephone. Please notify our office in advance (at least 24 hours prior to your scheduled appointment) if you need to cancel or reschedule your appointment(s).
Please review our office policies:
I have read and fully understand this Financial & Cancellation Agreement, and I agree to the terms listed above.