Our financial agreement as stated in office is as follows:
- Payment is Due At Time of Service.
- The parent bringing the child is responsible for payment.
- A monthly statement will be sent for any balance due detailing all charges, payments and credits entered on my account during the month preceding the closing date.
- No interest or finance charge will be levied against unpaid balances unless the balance is 60 days old. Interest rates will be 2% per month or 24% per annum.
- In case of default, the responsible party agrees to pay all costs of collecting payment; Including, but not limited to, reasonable collection agency fees, attorney fees, and court costs if applicable.
PAYMENT OPTIONS:
- Cash, Check or Credit Card in full, at time of visit
- Payments available on Approved Credit ONLY through
Care Credit, Chase Health Advance or Springstone Financial
- Pre-treatment payment in full for diagnosed treatment – 5%
discount when paid by Cash or Check 24 HOURS In Advance
INSURANCE:
We will give you an estimate of your out of pocket portion in advance of your services, based on the information your insurance company provides.The estimated amount will be due in full at the time of service. This office will submit all insurance claims on your behalf. We allow thirty (30) days for insurance claims to be honored. At the end of that time, payments must be made on all unpaid balances regardless of insurance status. Our staff will gladly submit a pre-treatment estimate to your insurance company so that you will know what your benefits will be.
USUAL AND CUSTOMARY RATES: Our practice is committed to providing the best dental care possible for our patients at rates that are usual and customary for our area. You are responsible for payment in full regardless of the interpretation of what is “usual and customary” by a given insurance company.
Should my account become delinquent, I agree to pay reasonable collection costs, attorney fees and courts costs as permitted by law if such are incurred by this office.