Patient Financial & Dental Insurance Information

This office is happy to help you process your insurance claim. We will complete our portion of the claim form and mail or electronically transmit your claim form promptly at no charge. For any services other than preventative, you will be responsible for your deductible (if it has not been met) and your estimated portion of the fee at the time of service. The remaining balance is due no later than 30 days after the insurance company has paid their portion unless a written and signed payment plan is on file in your chart. Any claims not paid within 60 days will be the responsibility of the patient and must be paid. Any disputes regarding the amounts paid will be between you and your insurance company. We will gladly supply any information requested by the insurance company. If payment is not received, a finance charge of 1.5% per month will be applied to your account on any unpaid balance due, whether it is your portion or a portion that you feel your insurance company should pay, until the account is paid in full.

The agreement for dental services is between the doctor and the patient, not with the insurance company or any third party payor. Therefore, should the claim for the service be rejected or applied to the patient’s deductible, the patient is ultimately responsible for payment to this office. Insurance coverage is limited to a portion of the fee agreed to by you in our office. There is categorically no such thing as a UCR fee for any nation, state, or zip code that is not created internally by the insurance industry. The limits of your coverage are based upon such things as premium amounts paid by your employer and profit margins designed by the insurance companies. The insurance companies are solely responsible for those numbers and they vary from company to company. When you receive treatment in this office, you agree to be financially responsible for the entire fee, independent of your insurance coverage.