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. Patients may require specific financial arrangements for any and all treatment.
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 that 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 $35.00 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 can then in turn be 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. We cannot access text messages and email is only available during 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 is 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)
We will bill all balances that remain on your account, after all insurance and co-pay amounts are applied, to your primary credit card on-file with the office. Please inform office personnel if you prefer to have a specific card used for billing. You will receive statement notification prior to any charges being applied. Emergency appointments after hours and on weekends incur an automatic $150 cash payment in addition to 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.
