Welcome
We strive to deliver high quality dental care to our patients with a professional level of customer service.
We also know how important it is to offer convenient payment options for treatment, at the onset of your treatment we will provide you with an estimate of your total treatment costs. Our goal is to help you afford your dental choices.
Please understand that we can only provide you with an estimate. Should the need for additional treatment arise during the course of the original treatment plan, the fees could change. Be assured that we will notify you of fee changes and obtain your approval prior to proceeding with treatment. Please take a moment to review the financial options offered.
■ Payment in full on the day of each visit. To demonstrate our appreciation for patients who are prompt with full payment, we will extend a five percent (5%) reduction of the total fee.
THIS APPLIES TO THOSE WITHOUT INSURANCE.
Cash, check, visa, master card, and discover accepted.
■ We are pleased to offer our patients an extended monthly payment plan option through a dental financing company Care Credit or Chase Health Advance. Please see front desk prior to treatment for more details and to receive a loan application.
■ Our goal is to help you maximize your dental insurance benefits. As a COURTESY we are happy to bill your dental plan for services. Please remember that the contract itemizing your dental benefits is between you, your employer, and your insurance carrier. Regardless of coverage, your estimated co-payment is due in full the day of treatment. If your dental plan does not pay within 45days of treatment, you must pay any outstanding balance and seek reimbursement from your dental plan. If your dental plan pays more than expected, you will receive a refund check within one week. Also remember that dental insurance plans are not designed to cover all of your dental needs. Rather, the amount your dental plan contributes towards your dental care is based on the plan selected and purchased by your employer.
I accept full financial responsibility for this account and for all dentistry performed upon my dependents in this dental office. I understand this it is up to me to confirm my insurance eligibility, waiting periods, and benefits. I also understand that this office cannot guarantee my insurance status in any of these areas. Any insurance estimate or information given to me by this office is not a guarantee of actual insurance payment. I also understand that any insurance claim not paid in full after 45 days will become my responsibility to pay at that time.
