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FINANCIAL GUIDELINESPatients with No Dental Insurance:Payment for dental services are due at the time of service, unless prior arrangements have been made. You may split the payments between number of visits. For instance, if you have an appointment for a crown, you may split the payments between two visits. One at the preparation appointment and one for the Seat visit. You may also choose to apply for the in-office financing such as Care Credit or Lending tree. Payments made with these methods are due completely at the time services are rendered.Patients with dental insurance:Co-payments and deductibles are due at the time services are rendered. As courtesy we agree to process YOUR INSURANCE claim for you. We deal with many different insurance companies and have a good idea what may or may not be covered. There are times that an insurance company denies a certain claim. We gladly write letters on your behalf and appeal their decision. But, services have been provided to you and ultimately you are responsible for the payment of your bill. Since you pay the premium payment to your insurance company, it is your responsibility to assist us in getting the payment for the services rendered. We allow three months for the complete payment of your balance. After that time, you will be billed for the portion that has not been paid for._______________________________ ______________Signature Date ................
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