This agreement is to clarify financial matters in our practice. We are committed to providing you the latest information to help you choose the care most appropriate for your situation. Optimum care is based on many factors including (but not limited to) technologic possibilities, prognosis, need, desire and finances. We are also committed to providing you with the information you need to make YOUR best choice. We can help you weigh risk, reward, benefits and alternatives.
All charges you incur are your responsibility regardless of your insurance coverage. Our relationship is with you, our patient, not with your insurance company. Your insurance policy is an agreement between you (or the plan admin) and the insurance company. You are personally responsible for all fees. We adhere to the insurance company agreements we have made. Reasonable requests for additional information are provided free, but charges can apply.
As a courtesy to you we will help process your insurance claims. You have your insurance company pay your benefits directly to our practice by signing the authorization on the Assignment of Benefits Agreement. If your insurance company has not responded within 60 days from date of service/submission, you will be expected to pay the balance in full.
Your estimated copayment for treatment (which is the amount not covered by your insurance) and items not covered by insurance are due at the time treatment is provided. As the insurance company NEVER guarantees their payment until submitted AND treatment choices are subject to change based on findings during care, the amount you pay is NOT accepted as payment in full. This balance will be adjusted after the insurance actually pays and you receive an updated statement.
Returned checks and balances older than 30 days will be subject to fees, &/or duplicate statement fees, &/or collection fees, as well as finance charges at the rate of 1% monthly. Invoices will indicate the portion due now and a phone call or email can clarify any question. Be timely to avoid charges, as it is truly our goal to avoid any fees besides those for care.
Our practice will charge you for appointments that you do not keep or appointments that you do not cancel with sufficient notice (2 full business days for non-surgical visits, 5 days for surgical visits.)
Please feel obligated to ask any questions regarding this agreement. A clear understanding of these policies helps provide the clarity for the positive experience we want for you. Our practice accepts cash, personal checks, and most credit and debit cards.
1) We will try to get as much information as possible so that specific and custom arrangements are made for payment.
2) "Outside financing": We work with several companies who provides payment plans-from months to years. Some have no interest, and some with modest interest (depending on terms you select). Fees we are charged are added to your total. We have their brochures and you can contact them directly (phone or internet), or we can help. They can determine their level of help. Any fees we incur in working with them is added to your total bill.
3) Insurance companies have frozen our fees or reduced our fees since 2008. A 3.0% usage/handling fee will be assessed for credit card use.