Thank you for choosing us for your Dental Home. We are committed to your treatment being successful. We strive to keep our fees as reasonably low as possible by having the following office policy. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our financial policy which we require that you read and sign prior to any treatment.
Understand that regardless of any insurance status, you are responsible for the balance due on your account. You are responsible for any and all professional services rendered. This includes but is not limited to: dental fees, surgical procedures, tests, office procedures, medications and also any other services not directly provided by the dentist.
Unless we receive notice of cancellation 48 hours in advance, you will be charged $35.00. We are committed to see you for your appointed time in a timely manner. Please help us serve you better by keeping scheduled appointments.
Please remember your insurance policy is a contract between you and your insurance company and that your employer contracts annually with the insurance for the policy in effect for a calendar year. Therefore, though you may have the same insurance company your benefits/ coverage may be subject to change yearly. We are not a party to that contract. As a courtesy to you, our office provides certain services, including a pre-treatment estimate which we send to the insurance company at your request. It is impossible for us to have knowledge and keep track of every aspect of your insurance. It is up to you to contact your insurance company and inquire as to what benefits your employer has purchased for you. If you have any questions concerning the pre-treatment estimate and/or fees for service, it is your responsibility to have these answered prior to treatment to minimize any confusion on your behalf. Please be aware some or perhaps all of the services provided may or may not be covered by your insurance policy. Any balance is your responsibility whether or not your insurance company pays any portion.
PAYMENTS DUE IN FULL AT TIME OF DENTAL TREATMENT:
- Full fees if patient does not have dental insurance
- Percentage not coverdy by you insurance
- Any amount over your yearly maxium
- Any fees not covered by you insurance
OUR CONTRACT WITH INSURANCE COMPANIES INCLUDES:
We do write-offs based on our contractual agreement. According to Kentucky House Bill 497 we do NOT have to write off for Alternative Benefits Clause, Missing tooth Clause, Yearly Limit Clause, or non Covered expenses. Our UCR ( Usual, Customary, and Reasonable) office fees will be charged to the patient.
OUR EXPECTATIONS OF YOU AS THE OWNER OF THE INSURANCE POLICY INCLUDE:
- Present to our office ALL CURRENT insurance information, INCLUDING MAILING ADDRESS. We request a copy of the insurance card at each visit and Drivers License, some Insurance carriers request the SS# as well.
- Any charges that are considered cosmetic or not medically necessary will be your responsibility and due in full on the day of service
- You are responsible for payment if the insurance company does not pay our office within 30 days. Once you have received your second statement, you need to call your insurance company and then contact us or your account will be turned over to collections.
- Keep our office informed of any changes in your insurance coverage or employment.
- You are responsible for notifying the insurance company of any requested personal information, change of family status, change in address, or change in dependants. WE CAN NOT GIVE OR CHANGE ANY PERSONAL INFORMATION WITH YOUR INSURANCE COMPANY. THE INSURER WILL NOT ACCEPT CHANGES FROM OUR OFFICE. A VIOLATION OF HIPPA.
FORMS OF PAYMENTS:
Cash, Checks, All Major Credit Cards ( American Express, Discover, Master Card, and Visa)
CARE CREDIT: We partner with Synchronicity Bank to offer 6 and 12 months same as cash depending on the total cost of treatment.
Unpaid balances over 30 days old will be subject to a re-billing fee of $2.00 each statement. If payment is delinquent, the patient will be responsible for payment of collection, attorney’s fees, and court costs associated with the recovery of the monies due on the account.
Should your account become delinquent and no attempt is made to make a payment or arrange a payment plan we will turn your account over to a collections agency and you will be responsible for any fees associated with the attempt to collect your debt. This will include but is not limited to collection fees, legal fees and if need be cost of small claims court. An account is considered delinquent 60 days after the date of service. If you do not call and make special arrangements your account will be turned over to collections and your account will start to accrue 3% finance charge.