To Our Valued Patient – Office Procedures and Billing Policy

We are here to serve you in a comfortable and professional atmosphere. We are committed to providing you with the very best quality of dental care. Our goal is to make your experience an exceptional one. If your visit with us did not meet your expectations, please tell us. Your opinion matters and helps us determine the areas where we are doing well and where we can improve.

1. Your appointment time is a reservation between you and the Dentist or Hygienist and is set aside especially for you. We ask that you please arrive at least 10 minutes in advance of your scheduled appointment time. New patients, please arrive 20 minutes early. If you do not arrive 20 minutes ahead of your appointment time, we cannot guarantee that all services will be able to be completed as the staff will be limited in the amount of time allocated to treat you. Failure to keep a scheduled appointment not only compromises your dental health but prevents other patients from receiving necessary care and increases the cost of delivering care for everyone. If you must change an appointment, we request notice a minimum of 2 business days in advance. Although we understand that emergencies do arise, there is a $50 fee for all broken appointments (no shows) or appointments cancelled without 2 business days notice, regardless of the reason.  Appointment changes and cancellations are not accepted via text, email or voicemail as this is not our main form of communication and they can be missed.  Please call us during our business hours and speak to an employee in order to make the necessary changes to your appointment.

2. Our office prides itself on making the very best treatment recommendations for your overall dental health. Therefore, we do not let insurance limitations and allowances dictate our treatment recommendations. It is important to remember that you are a partner with us in your oral health and that treatment decisions should be made together, based on your actual needs. Your dental plan may not cover the full cost of the specific treatment that you require. Many plans only provide for the least expensive course of treatment, regardless of the decision made by you and us as to the most effective and necessary treatment required.

3. Any estimated out-of-pocket expense is due in full prior to or at the time treatment is provided. For your convenience, we accept checks, cash, Visa, Master Card and Discover. We also have several financing options available and would be happy to discuss them with you.

4. If you have insurance, it is your responsibility to be aware of what your dental benefits are, the details of your coverage, and if you have used a portion of your benefits at another office. Additionally, network participation is not guaranteed. It is your responsibility to know if the doctor that is treating you is actually “In-Network” or “Out-of-Network” with your insurance plan. This “participation status” will alter your insurance coverage. As a courtesy to you, we will estimate your patient responsibility. The estimated patient responsibility is due prior to or at the time of your visit. Please be advised that this is an estimate only, and although we gladly file insurance claims for you, any and all balances and uncovered procedures are ultimately your responsibility. The practice depends upon reimbursement from the patients for the costs incurred in their care, and we cannot render services on the assumption that our charges will be paid by an insurance company. All insurance benefits are assigned to the Doctor and dental records may be released to the insurance company.
Any balances that have not been satisfied by insurance that are over 60 days old are ultimately your responsibility.

5. We will be fair in working out special finances with you, but please also be fair to us with your commitments. There will be a $3.00 rebilling fee incurred for each additional statement on overdue balances. There will be a $35 cancelled check fee applied to your account in the event that your check payment should not clear for any reason. Any collection fees will be your responsibility.

(This form will be signed using an electronic signing pad when you arrive at the office.)