If your dental insurance has changed please notify office staff via email at email@example.com before your next visit so we can make the appropriate changes to help you receive your maximum benefits. Failure to notify us of changes may leave you responsible for payment of services. As a courtesy to our patients, we will submit claims to your insurance carrier for you; however, we cannot predict or guarantee what part of our services will or will not be covered by your particular plan.
- Guarantor’s name
- Guarantor’s DOB
- Guarantor’s SSN
- Guarantor/Subscriber ID number
- Guarantor/Subscriber Employer
- Group number
- Insurance Company Phone number
- Full insurance company name
It is our primary goal and responsibility to help our patients obtain good dental health. We wish to direct our time and energy toward obtaining that goal. We have prepared this page so that you may be aware of our financial policy.
Payment options include the following:
- Visa, MasterCard and Discover
- Personal checks are not accepted
- Financing options (pending credit approval)
- In-house financing
Payment in full is expected before treatment is initiated. Patients with dental insurance must provide accurate and complete insurance information. We will be happy to file for your insurance benefits as a courtesy to you, but we are not obligated to do so. Although rare, some insurance carriers will not reimburse our office directly. In such instances, you will be responsible for the full cost of each visit at the time services are provided, and your insurance company will send you the reimbursement check directly.
Important Information regarding dental benefits:
- Our relationship is ultimately with you and not your dental insurance company. Your dental insurance is a contract between your employer and the insurance company. The percentage covered for each procedure is determined by how much your employer has paid for coverage.
- Most plans routinely pay between 50-75% of the average total fee.
- We want to provide our patients with the finest treatment available and base our treatment recommendations on what will be best for your child rather than what your insurance company does or doesn’t pay.
- Every effort will be made to provide a treatment plan fitting your timetable and budget. Our primary goal is to provide your child with the best possible treatment in a safe environment, using high quality supplies and medications.
- Unfortunately, the goal of many insurance companies is only to treat patients in the least expensive manner, not necessarily the safest or most effective.
- At the initial appointment, you will be responsible for your portion of the fees not covered by your insurance for that appointment and payment is expected.
- We will be happy to assist you in estimating your portion of the cost of treatment, but we would strongly recommend you become familiar with your insurance benefits ahead of time.
- Prior to completing any restorative treatment, we will provide you with a cost estimate of our total fee, your estimated insurance coverage, and your estimated out-of-pocket costs. Please remember, these are only estimates and may change during the course of treatment.
- Sometimes, treatment alternatives become necessary for various reasons, which may increase or decrease treatment costs.
- Further, most insurances do not tell us exactly what they will pay, so we are only giving you our best guess.
- Any amount not covered by your insurance company is payable at the time services are rendered. These fees may include deductibles, co-payments or certain procedures not covered by your insurance policy.
If you have any questions, we will be happy to assist you. We look forward to beginning a wonderful relationship with you and your child! Please do not hesitate to call.