Dear Patient:

Thank you for choosing us as your dental health care provider. The following is our Financial Policy. Our main concern is that you receive the proper and optimal treatments needed to restore your health. Therefore, if you have any questions or concerns about our payment policies, please do not hesitate to ask our office manager. We ask that all patients read and sign our Financial Policy and Dental Materials Fact Sheet (by request) as well as complete our Patient Information and Consent Form prior to seeing the doctor.

Payment for services is due at the time services are rendered. We accept cash, checks, and for your convenience, MasterCard, Visa and Discover. We will be happy to help you process your insurance claim for your reimbursement as long as you provide us with all necessary information in doing so.

In special instances, we may accept assignment of insurance benefits. However, you must understand that:

  1. Your insurance policy is a contract between you, your employer and the insurance company. We are not a party to that contract and cannot guarantee any payment by your insurance company. Our relationship is with you, not your insurance company.
  2. All charges are your responsibility whether your insurance company pays or not. Not all services are a covered benefit in all contracts. Some insurance companies arbitrarily select certain services they will not cover.
  3. Fees for these services, along with unpaid deductibles and co-payments are due at the time of treatment.
  4. If the insurance company does not pay your balance in full within 30 days, we ask that you contact the carrier to help speed things up.
  5. If the insurance company does not pay in full within 45 days, we require you to pay the balance due with cash, check, MasterCard, Visa or Discover.
  6. Returned checks and balances older than 45 days may be subject to additional collections fees and interest charges of 1.5 % per month.

Please note that, unless canceled at least 24 hours in advance, you may be charged for missed appointments. Please call if you have to reschedule.

We understand that temporary financial problems may affect the timely payment of your balance. We encourage you to communicate any such problems so that we can assist you in the management of your account. Again, thank you for choosing us as your health care provider. We appreciate your trust in us and we appreciate the opportunity to serve you.