Our Payment Policy

1. Payment in full for each appointment is expected on the day that service is rendered.

2. If insurance benefits cannot be confirmed you will be expected to pay the cost of the initial appointment on the day of that appointment. We will accept payment for further treatment directly from your insurance company; however, if we do not receive payment from the company within six (6) weeks after the completion of treatment, you will be expected to pay for all dental services. In the event of duplicate payment you will be reimbursed.

3. Remember, even if you have insurance, YOU ARE RESPONSIBLE FOR PAYMENT OF YOUR ACCOUNT. We will be happy to help you receive the maximum benefits under your policy. However, please remember that the relationship is between you, the insured patient, and your insurance company. Verifying benefits is not a guarantee of payment by insurance.

4. We will file most insurance claims for you; we will also determine the “estimated percentage of payment” for which you are responsible.

5. You must expect to pay a percentage of the cost of treatment at each visit. We will accept payment directly from your insurance company, but please remember that insurance companies rarely cover all of the costs of treatment and often take up to three (3) months to pay. Our expenses continue during this period, and we cannot hold an account open with no payment whatsoever for that length of time. We will refund to you any duplicate payments that are made.

6. Please be aware that the parent or guardian bringing the child to our office is legally responsible for payment on all charges.

7. Balance after insurance pays is due within ten (10) days of billing statement.

8. Bank charge cards: Visa, MasterCard, Discover, and American Express are accepted

9. Appliances: One-half of the cost of the appliance must be paid on the day your child’s teeth impressions are taken. This is necessary because our office must pay the lab bills when appliances are ordered, not when they are completed. The remainder of the cost of the appliance is due the day the appliance is delivered to your child.

10. A Behavior Management fee may be charged when excessive time and modified techniques are rendered beyond normal measures to gain the child’s cooperation and when certain measures of restraint (papoose, extra assistants) are used for the child’s safety and in order for the doctor to render the child’s treatment effectively and efficiently.

There is a billable insurance code for Behavioral Management fees, however most insurance companies decline to pay this fee. Our fee is $75.00 per 15 minutes of time we need to complete the service being done.

11. There is a $25 charge for all appointments that are missed or canceled with less than 24 hours’ notice.

12. Personal checks are accepted with proper ID. Should your check be returned for insufficient funds there is a $30 fee, court fees, and attorney fees.

13. Refunds of less than $10.00 will be held as a credit on patient’s account.

Charges and Billing

For accounts with an outstanding balance, an itemized statement covering your family’s monthly dental services will be mailed out each month. The statements will cover charges and payments for sixty (60) days. During regular business hours, our office staff will gladly answer any questions you may have about your statement.

All accounts with a balance due will receive a monthly statement until the account is paid in full. After ninety (90) days. A $5.00 billing charge is added. All accounts over thirty (30) days old are subject to a 1.5% service charge per month (minimum $1.00). The annual rate is 18% exclusive of minimum. If the account is turned over for legal collection the responsible party agrees to pay for all costs of collection including attorney’s fees of 30% of the unpaid balance plus service charges and costs.

If it is necessary for someone other than a parent or guardian to accompany your child to our office, you must provide them with a signed insurance form or payment of services rendered, or we WILL NOT see your child. We will be happy to quote you the anticipated cost of the visit if you will call the office prior to the appointment.

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