We pride ourselves on offering the best customer service available and will gladly submit your claims to any insurance company you prefer. Remaining payment of the patient’s portion is due no later than the day the dental service is rendered except for extensive treatment, Six-Month Smiles treatment, and Clear Aligners.
All treatment plan costs presented are ESTIMATES only; I will be responsible for the applicable financial differences. I understand that my specific policy is an agreement between the insurance company and me, and I am responsible for any financial differences. Should, for any reason, the insurance benefits result in less than the coverage anticipated, I understand that I am the responsible party for the total obligation.
Every effort is made to bill my insurance directly for reimbursement; however, if they do not pay within 60 days, I am still responsible for all remaining treatment fees. If I fail to notify Awesome Smiles of any insurance change, I will be fully responsible for any amount not paid by my insurance.
I agree to pay finance charges of 1.5% per month (18% APR) on any balance 60 days past due. If sent to collections, I agree to pay all related fees and court costs. Any check not cleared through the bank and returned to our office because of an insufficient balance will incur to the patient a $40.00 service fee.
There are many times that our patients require urgent or emergency treatment and therefore require an appointment as soon as possible. When patients give the office advance notice of their need to cancel a scheduled appointment, this time is allocated to these patients in urgent need of treatment. In this way, the office can best serve the needs of ALL patients. With this in mind, a fee of $75/person/30 min is charged for patients who cancel without a 48-hour notice, which does not include after office hours, weekends, text, or email. Staff cannot access text messages or emails outside of office hours. For sedation patients, a 72-hr notice is required.
To reserve time with the doctor, a portion of the patient’s co-pay may be due at the time of scheduling. Any remaining payment is due on the day the dental service is rendered except for extensive treatment, Six-Month Smiles treatment, and Clear Aligners. Payment Options: Cash, Check, Visa, Mastercard, Discover, CareCredit (not all co-pays qualify), and Lending Club (allows payments over time with little to no interest)
Any medical or dental payments sent directly to you mistakenly must be brought to the office within three (3) business days of receipt. Please make sure to bring the entire explanation of benefits with the payment to balance your account. Refunds are issued after all claims have been filed, and all payments posted to your account. Failure to do so will result in collections initiated on your behalf or notice of income sent to the Internal Revenue Service (IRS).
We will bill all balances that remain on your account, after all, insurance and co-pay amounts are applied, to the last credit card used in the office. Please inform office personnel if you prefer to have a specific card used for billing. We will send a statement via mail and/or secure email prior to any charges being applied. Emergency appointments after-hours and on closed weekends incur an automatic $150 cash payment due before being seen, in addition to fees for any treatment completed during the appointment. Failure to come to the scheduled emergency appointment will still incur the charge if the doctor is not notified and arrives to treat you, but you elect not to come.
