PATIENT INFORMATION

• Introduction
• First Visit
• Scheduling
• Financial Policy
• Insurance
• Patient Registration
• Endodontic FAQ
• Financial Agreement
• Treatment of Minor Children
• Directions

Financial Agreement

Thank you for choosing our specialty practice!  We are committed to complete disclosure regarding your dental treatment.  We want you to recognize that payment of your bill is your responsibility.  The following is a statement of our Financial Policy, which we require you read and sign prior to treatment.  We welcome any questions.

We accept Cash, Checks, Visa, Mastercard, Discover, Am Ex and Care Credit

PATIENTS WITHOUT INSURANCE:  Payment in full is required on the day of treatment.

REGARDING INSURANCE:  Our office is pleased to accept your insurance assignment.  As soon as your exact coverage is verified, we will file our claim forms and assist you in getting your claim paid.  Remember your dental insurance is provided through a contract between your employer and the insurance company.  Because this insurance covers only part of the root canal fee, each patient is responsible for paying the balance of the fee upon completion of the root canal.  Our office cannot guarantee payment by your insurance Company, but we will make every attempt to help you receive the maximum reimbursement to which you are entitled.

We are not participating providers for any Dental Insurance Plans.  We will file your insurance claim.  All estimated deductibles/co-pays are due in full on the day of treatment.

CARE CREDIT FINANCING:  Our office accepts Care Credit, a dental credit card through GE Financial.  A short application with a credit check is required.  We can initiate the application process within our office, or you can contact them directly online at  ______________ or by phone at 800-365-8295.

DELTA DENTAL PATIENTS:  Because your insurance mails the reimbursement directly to you, payment in full must be arranged on the day of treatment.  Our office offers limited in-house financing (Balance in three months) and longer term financing through Care Credit.  We request you speak to one of our office staff before going back to the treatment area should payment be of concern to you.

USUAL AND CUSTOMARY RATES:   Insurance plans limit benefits to a "Usual and Customary" rate, which may reduce your insurance reimbursement.  Our office does not adjust our fees; therefore you are responsible for any difference.

EMERGENCY PATIENTS:  The emergency portion of the treatment visit will be $375.  this portion will be credited toward the total cost of the root canal, and is not an additional fee.