FINANCIAL POLICY STATEMENT

The primary purpose of this policy is to keep the cost of your dental services as affordable as possible. It will also allow us to handle all accounts in a consistent manner.

For all dental procedures, payment may be made in the following manner:

1. Payment in full at the time of service. This may be made by cash, check, or bankcard. If you have dental insurance, we will assist you in completing all the necessary forms to obtain your maximum reimbursement.
   
   
2. Assignment of insurance benefits to our office. If you would like insurance benefits to be paid directly to our office, your account can be handled in the following way:

A. The balance on your account following insurance payment will be placed on your bankcard. This will allow you to pay your balance approximately 60 days after the date of service or to budget payments with the bank.

B. If you prefer not to use a bankcard to pay your balance, we will estimate your portion of the charges. You may bring in your "benefit book" that describes the co-payments in detail. In the absence of a benefit book, we will estimate using the following guidelines:

Preventive Services 100%
Restorative Services 80%
Major Services 50%

*** We will assume a $50 deductible per patient per year ***

If there is any overpayment following insurance benefits, you will be promptly refunded.

For all accounts which presently carry balances, we will institute a repeat billing charge of $5.00 per month if no payments are received. If no payments are received for 90 days, the account will be turned over to an outside agency for professional collection.

There will be a $20 fee charged for appointments broken without 24 hours notice.
Exceptions will be made on an individual basis.

If you have any questions or problems, please speak with the office manager.

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