Charges for all services are the responsibility of the patient, whether or not covered by insurance. We will file insurance claims for patients if we have a current copy of the patient’s insurance card on file. However, all patient payments, non-covered service charges, and deductibles as required by your insurance are due at the time of service.

Each insurance plan has a different set of procedures that are eligible for payment, and may have limits on the number and timing of visits, x-rays, and procedures. We may not know at the time of your visit if your insurance company will pay for all services and you may not be notified that a service is not covered at the time of your visit. If your insurance company does not pay for these services, you accept responsibility for full payment of these charges. Charges for certain procedures must be paid for by you prior to having the service provided.

Regulations mandate that insurance companies pay for undisputed claims within 30 days of submission. We will allow 45 days for your insurance to pay a claim. If your insurance company has not paid in full by this time, you will be responsible for all outstanding charges. Please follow up with your insurance company to make sure they pay your claims. We will refund any overpaid amount to the patient or insurance company as appropriate.

We rely on the insurance information you give us in filing insurance claims for you. If we do not have correct insurance information at the time of service we may not be able to file your claim before the “timely filing” period ends. If the insurance information that you provide us is not accurate, you will be liable for the full amount of all charges and agree to pay these charges in full.

Payment -We accept cash, credit cards, checks and we participate with Care Credit patient financing.

Account Credits – If you or one of your family members has a credit on their account, you authorize us to use that credit at any time toward payment of any amounts owed on either account. Credits of $20 or less may be left on account without notification. 

Delinquent Accounts – Once we have exhausted our internal efforts to obtain payment for service, we will refer accounts to an outside collection agency. These agencies report delinquent accounts to credit reporting services. You will be charged and agree to pay a $50 fee and for all collection and/or attorneys’ fees that we may incur trying to collect on your account. 

Returned checks – Occasionally, a check written to us is returned unpaid. Returned checks must be paid in full within 10 days of notification plus a $40 fee and must be paid in cash or with a money order or cashier’s check.

Medical records fee – I understand that federal and state laws allow for a fee to be charged for copying of patient records and I will be personally responsible for the payment of such fees. One copy of up to 75 pages of patient records will be provided at no cost. Any records over 75 pages and any records after the first copy will be billed at the current rates payable prior to records being released.

Scheduling – Patient who do not show up for an appointment, arrive too late, or cancel with less than 24 hours’ notice, may be billed and agree to be responsible for full payment of a $50.00 charge. Broken appointment for surgery or major procedures will result in a $100.00 charge due to the amount of time scheduled and advance planning required.

Safety – For safety and liability reasons, only the patient may be in the treatment room during treatment. Allowing a child in the room while the parent is being treated puts the child at risk for injury from sharp instruments, chemicals, and/or bacteria aerosols present in the room. Children are welcome to wait in the reception room but we are not responsible for the safety or supervision of children in the reception room. 

Prescriptions – Please allow 24 hours for processing the refill of any prescription. Current law does not allow narcotics to be prescribed by phone, a written prescription is required. Narcotics will not be prescribed after hours or on the weekends, and lost or stolen prescriptions will not be replaced.