Financial Policies and Options
We have several financial policy options available for your convenience in receiving the proper dental care.
We have found that our patients appreciate knowing exactly what dental financial responsibilities they will incur. Therefore, we inform our patients about our financial policies before we begin treatment. Knowing this ahead of time allows us all to arrange for the completion of the necessary dental treatment. In order to facilitate access to the very best health care possible, you can choose from any of the following.
You need to bring your insurance card to your first visit and at any time your insurance changes.
You need to be aware that:
- We will always do our best to help you to maximize your benefits.
- Your treatment plan is individually tailored, and is not based on your dental or medical insurance benefits or lack of benefits. Some insurance companies arbitrarily select certain services they will not cover. It is your responsibility to thoroughly understand the coverage and exceptions of your particular policy. Coverage issues can only be addressed by your employer or group plan administrator. We cannot act as a mediator with the carrier or your employer.
- As a courtesy to all of our insured patients we will gladly process your insurance claim forms. We understand insurance guidelines can be difficult to understand and overwhelming at times. Fortunately with the information provided to us by your insurance company we are able to provide some assistance in estimating your insurance benefit. However, your insurance company makes the final determination once treatment in completed and the claim submitted. Your insurance is a contract between you and your insurance company; therefore, all charges are your responsibility. All deductibles and estimated co-pays must be paid at the time of service. Any payments made directly to you by your insurance company on unpaid balances should be forwarded immediately to our office so that your account may be credited accordingly. The filing of an insurance claim does not relieve you of timely payment on your account. If the claim is not cleared by your carrier in 45 days, the unpaid portion will automatically become “self-pay” and a statement will be sent to you. You are responsible for any amounts your insurance company chooses not to pay, for whatever reason. Any amounts expected to be paid by your insurance company, but not cleared by them within 45 days become your responsibility and, if not paid in a timely fashion, will begin to be charged a billing fee of $10.00 per monthly statement.
Please feel free to contact your insurance company directly regarding your coverage with our office or any unpaid benefits should you have questions. We will gladly provide you all pertinent information that you may need.
I understand and accept the financial and the dental or medical insurance policies listed above and have had any and all questions answered to my satisfaction. I agree to pay for all treatment in a timely fashion as described so as to avoid any additional fees.[For those patients with dental or medical insurance who would prefer that their ins. co send payment to this office.] I hereby authorize my insurance benefits to be paid directly to Dr. Llanas. I realize that I am responsible to pay for any deductible amount(s), my co-insurance portion and for any non-covered services. I understand that I am financially responsible for any and all charges of dental treatment and incurred fees, whether or not paid by said insurance and I agree to pay such charges in full. I also hereby authorize the release of pertinent medical/dental information to the insurance carrier(s). A photocopy of this assignment is to be considered as valid as the original.
The primary goal of our dental practice is to provide the highest quality oral health care in the most gentle, efficient and enthusiastic manner. Since our practice is also a business with obligations that must be met, we ask that all patients pay for their treatment in full on the day of each visit to our office unless prior arrangements have been made.
We will do our best to give you a rough estimate of your investment in your dental health for each upcoming visit, based on your individual treatment plan. You will be given a very close estimate of your next visit’s total bill. Please bring cash, check or credit card at the time of treatment. With a proper diagnosis and a timely treatment plan, most estimates we provide are accurate.
Outstanding balances on your account are discouraged, and must be cleared before the next appointment for any account member or within 30 days of treatment, whichever comes first. Appointments for non-emergency treatment may need to be postponed pending payment of outstanding balances. Amount due and not paid in full within 30 days will be charged a $10.00 monthly billing fee per statement.
Delinquent balances over 90 days old will be referred to a collection agency.
A returned check fee of $40.00 (subject to change as bank fees increase) will be added to your account for any returned check. Before we accept another payment by check, the $40.00 fee plus full payment for the check that did not clear must be paid in cash, or by VISA or MasterCard.
Your dental appointments are scheduled carefully. Time, trained personnel and dental equipment are reserved for each procedure. Missed appointments add to the cost of dental care when reserved facilities are left waiting empty. We request 24 hours advance notice for rescheduling your appointment. Your account will be charged a broken appointment fee of $50.00 for missed appointments without proper notification.
All products must be paid for in full at the time of purchase.