FINANCIAL POLICY

 

PLEASE CAREFULLY READ THE INFORMATION BELOW BEFORE SIGNING.


dental insurance

 We will file your insurance claims with your primary insurance company as a courtesy to you.  You must provide us with an insurance card and all the information necessary to verify your coverage and file your claim.

Your insurance policy is a contract between you and the insurance company. We are not a party to the contract. It is your responsibility to understand your insurance policy with regards to benefits, maximum balances, limitations, exclusions, waiting periods, etc.

Eligibility is not a guarantee of coverage as actual benefit payments are determined only when a claim is processed.  We may estimate your insurance benefits but the insurance company makes the final determination of benefits. Therefore, any balances remaining after insurance pays on claims becomes your responsibility. We do not file claims for medical or secondary insurance.

 

Payment Policy

Any estimated copayments and deductibles required by an insurance company must be paid when service is rendered. 

We accept cash, personal checks, debit, cards, Visa, MasterCard, American Express, and Discover and for those who qualify, we also accept Care Credit.  Care Credit offers no interest financing for up to twelve (12) months.  If you choose to pay cash in full we will gladly extend a 10% cash savings.

After your dental insurance has paid its portion, a statement is sent to the mailing address on record for the remaining balance.

 

Returned Checks

A $30.00 charge applies when a check is returned by the bank.

 

Missed Appointment Fee

There is a $50.00 fee for cancellations not made 24 hours prior to scheduled appointments.  Please call our office at least 24 hours prior to your scheduled appointment if you are unable to keep your appointment.  If an appointment with a specialist is missed or cancelled, a deposit will be required prior to rescheduling the appointment. 

 

PAST DUE ACCOUNTS

An account with an unpaid balance past 90 days will be sent to the collection agency.  At that time you will be responsible for any and all costs incurred in the collection of your debt:  an interest rate of 21% on the unpaid balance from the last date of service, attorney fees, court fees and any other fees associated with the collection of your debt.

We understand temporary financial problems may affect timely payment of your balance.  In those situations, we encourage you to communicate any such problems immediately so we may assist you in the management of your account.

 

finance charge

A finance charge will be imposed if your account has not been paid within sixty (60) days of the time the procedure was added to the account. The finance charge is equivalent to one and one half percent (1.5%) per month or an ANNUAL percentage rate of (18%) percent. The minimum finance charge is $.50.

 If you would like a copy of our financial policy, you can download it here.

CONSENT & AUTHORIZATION

By signing below, I agree that I have read and understand Valley Creek Dental Care's Financial Policy in its entirety. I understand that payment is expected when services are rendered. Any balance not paid by my insurance company is my responsibility, regardless of the reason for non-payment. If the patient is a minor, please put the name of the responsible party. *
By signing below, I agree that I have read and understand Valley Creek Dental Care's Financial Policy in its entirety. I understand that payment is expected when services are rendered. Any balance not paid by my insurance company is my responsibility, regardless of the reason for non-payment. If the patient is a minor, please put the name of the responsible party.