Forms & Policies

New Patients

Please access our Patient Area here to complete your online registration.

Payment at Time of Services

We request that payment be made at the time you receive services in our office.

Payment Options

We realize that every person’s financial situation is different. Therefore, we provide several payment options to our patients. For your convenience, we accept cash, personal checks, bank debit cards, and major credit cards (Visa, MasterCard, Discover, and American Express). We also offer interest-free financing through Care Credit. For more information, please visit www.CareCredit.com.

Insurance

If you have dental insurance we will gladly submit your claim on your behalf. However, we cannot guarantee any estimated coverage, as the insurance policy is an agreement between you and your insurance carrier.

No Insurance Pays 100% of All Procedures

Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90-100% of all dental fees. This is not true! Most plans only pay between 50-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage or the type of contract your employer has set up with the insurance company.

Benefits are Not Determined by Our Office

You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist’s actual fee. Frequently, insurance companies state that the reimbursement was reduced because your dentist’s fee has exceeded the usual, customary, or reasonable fee (“UCR”) used by the company. This can be very misleading and simply is not accurate.

All of our fees have been accepted by Delta Dental (considered the standard for dental insurance companies), as usual and customary. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.

Deductibles & Co-Payments Must be Considered

When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for a service is $150. Assuming that the insurance company allows $150 as its usual and customary (UCR) fee, we can figure out what benefits will be paid. First, a deductible (paid by you), on average $50, is subtracted, leaving $100. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100 or $80. Out of a $150 fee they will pay an estimated $80 leaving a remaining portion of $70 (to be paid by the patient). Of course, if the UCR is less than $150 or your plan pays only at 50% then, the insurance benefits will be significantly less.

OUR OFFICE POLICY REGARDING DENTAL INSURANCE

Your estimated co-payment is due the day treatment is initiated. Our office will do what we can to create this estimate as a courtesy to you. While we gather as much information from your insurance plan as possible, this amount is purely an estimate! Since we are not contracted with your insurance company there is no guarantee that your insurance will pay the exact remainder of the fee.

If we have received all of your insurance information on the day of the appointment, we will be happy to file your claim for you. You must be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. We will file insurance electronically so your insurance company will receive each claim within days of the treatment. By law, your insurance company is required to pay each claim within 30 days of receipt. You are responsible for any balance on your account after 30 days, whether insurance has paid or not. If you have not paid your balance within 30 days. a finance charge of 1.5% will be added to your account each month until paid. We will promptly send a refund to you if your insurance pays more than was expected.

PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. We do not have a contract with your insurance company, only you do. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment. We at no time guarantee what your insurance will or will not do with each claim. We also cannot be responsible for any errors in filing your insurance. Once again we file claims as a courtesy to you.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.