Our goal in discussing financial arrangements relative to your dental needs includes:
- to inform you of treatment alternatives
- their respective advantages and disadvantages
- the consequences and/or risks of limited delayed treatment and/or non-treatment
We will discuss with you the costs of the dental treatment and alternative treatment. We will gladly answer your questions until you are completely satisfied.
We are happy to assist you in receiving your maximum dental insurance benefits. Dental insurance is a contract between your employer, who selects your coverage limits, and the insurance company. You (the subscriber) will receive the dental benefits as defined within this plan. Insurance payments received by this office will be credited to your account or refunded to you in the case of an overpayment. We cannot guarantee insurance carrier payments on office-generated insurance reimbursement estimates. You are responsible for all dental fees (charges) that your insurance company has not paid, for whatever reason, within a 60-day period from when treatment is begun. You will be expected to pay the full amount due.
Our office will accept assignment of dental insurance benefits directly to our office. Please bring your dental plan benefits booklet to our office to allow our staff to make a reasonable estimate of what the insurance company will pay for a given dental procedure. For an exact statement of benefits, a pre-determination of benefits form can be sent to the insurance company. The insurance carrier will return the form stating their payment and your co-payment responsibility.
In addition to accepting payments directly from your insurance carrier, financial arrangements need to be made for your co-payment. The co-payment is the difference between the treatment costs and the insurance payment.
Fee Guarantees and Nonpayment Procedures
We are obligated by state regulations to be certain you understand your dental treatment needs, appropriate treatment and options, fees involved, and financial arrangements. The estimated fees we provide for dental services are guaranteed for 90 days. If treatment is not begun within 90 days of the estimate date, cost of dental treatment could vary. Once dental treatment has begun, changes in the anticipated treatment plan may be required, depending on oral conditions encountered. You will be informed if this occurs and given the option of continuing treatment, changing treatment, or canceling treatment.
If your balance becomes 60 days or more overdue, our office reserves the right to interrupt or discontinue dental treatment and/or send your account to an attorney for collection. In the event that your account is sent for collection, you will be responsible for all costs and fees, including reasonable attorney's fees, incurred. If payment is not made within 30 days, your account may be charged at a rate of 1.0 % per month.
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