LOWERY DENTAL CENTER



LOWERY DENTAL CENTER

SITI A. LOWERY, DDS, PA

FINANCIAL POLICY

Insurance Policies:

If you have dental insurance, we will accept assignment of your insurance benefits. However we require your portion of the bill (co-payment) to be paid at time of service. The balance due is your responsibility whether your insurance company pays or not. We accept cash, checks and all major credit card payments. Third party financing is available to qualified individuals through Care Credit. We are currently contracted providers for Metlife, Delta Dental, United Healthcare Dental & Cigna only. Please inform us of any changes in your insurance plan or policy. Failure to do so may result in denial of coverage, the fees for which you will be held responsible.

Indemnity Plans/Usual and Customary Fees:

If you have an indemnity plan that we are not a preferred provider for, your insurance is a contract between you, your employer and your insurance company. We are not a party to that contract. Please be aware that some, or all of the services provided may be non-covered services and not considered reasonable and/or necessary under your insurance. Should we not participate with your particular insurance company, you are responsible for payments regardless of your company’s arbitrary determination of usual and customary rates.

Service Fees/Delinquent Accounts:

Returned checks are subject to applicable back fees of not less than $25.00. A delinquent billing charge of $25.00 plus interest at the rate of 1.5 % per month (18% annually) will be assessed to all account balances over 60 days as provided by state law. Overdue/unpaid accounts will be subject to collections actions.

Minor Patients:

The adult, parents, or guardian accompanying a minor are responsible for full payment of services. For unaccompanied minors, non-emergency treatment will be denied unless charges have been pre-authorized to an approved credit plan, credit card, or by check or cash at time of service.

Broken Appointment Policy:

We understand schedules sometimes change on short notice, but we kindly request the courtesy of 24 hours notice if you need to cancel an appointment. We reserve the right to charge $37.25 per hour for missed/broken appointments. Please help us serve you better by keeping your scheduled appointments.

Appointment Deposit Policy:

All appointments requiring 90 minutes (or more) of treatment time will necessitate an Appointment Deposit of $100. This deposit holds your appointment time with Dr. Lowery & will be applied to your account toward treatment services. However, failure to comply with our 24 hour cancellation policy will result in a forfeiture of that deposit.

Thank you for your understanding of our Office Financial Policy. If you have any questions, please do not hesitate to ask. By signing below, I am indicating that I have read and understand the Financial Policy of Lowery Dental Center, Siti A. Lowery, DDS, PA, and that I agree to abide by these policies as dental services are provided to me and any member of my family.

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