It is the goal of our practice to provide not only the finest care available, but also to provide financial services that do not cause undue hardships. Patients will be scheduled for treatment after financial arrangements are made with our Financial Associates regarding all treatment.
OUR FINANCIAL ASSOCIATES ARE AVAILABLE TO ANSWER ANY QUESTIONS YOU HAVE.
Our office requires a 24 hour notice if you are not able to make your appointment. If we do not receive this notice, a fee of $75.00 will be charged to your account.
X-ray Requirements—We pride ourselves in delivering the highest standard of care; therefore, complete diagnostic x-rays are necessary. We require a complete series of x-rays on new patients and patients who have not been to see us on a regular basis. If you have had this series done with another dentist in the past three years, we ask that you bring them with you on your initial visit. IF YOU DO NOT HAVE THEM OR ARE NOT ABLE TO RETRIEVE THEM FROM YOUR PRIOR DENTIST BEFORE YOUR APPOINTMENT WITH US, WE WILL NEED TO TAKE X-RAYS AND BILL YOU.
Insurance Policy—The patient is always expected to pay his/her portion at the time of service, including co-pay and deductibles. As a courtesy to all of our patients with insurance, we will file dental services with your primary insurance company, and if applicable your secondary insurance. The normal time allowed for insurance response is 30 days. Any charges remaining on your account after your insurance pays are ultimately your responsibility.
Payment Policy- Our office requires payment in full for all services rendered at the time of visit, unless other arrangements have been made with the financial department. If other arrangements are made with our finance department, the patient authorizes CAI DENTISTRY to make such inquiries with any credit bureau regarding financial responsibilities that are deemed necessary.
Collection Policy- If your account becomes delinquent and no financial arrangements have been made, you will be responsible for legal fees, interest charges, 33 1/3% attorney fees, and any other expenses incurred in collecting your account balance. All work must be paid in full at the time of service once your account has been satisfied with the attorney.
AUTHORIZATIONS FROM PATIENT
I authorize CAI DENTISTRY to perform any necessary services needed during diagnosis and treatment. I also authorize the release of any required information to outside health practitioners and for the purpose of processing insurance claims.
I understand that my insurance policy is a contract between me and my insurance company(ies) and that I am responsible to CAI DENTISTRY for all fees.
I authorize and request my insurance company (if applicable) to pay directly to the dentist or dental group insurance benefits otherwise payable to me. I understand that my dental insurance carrier may pay less than the actual billed services and that I am responsible for the remaining balance.
