We would like to welcome you and your child to our practice. For us to provide you with optimal service, we would like you to take a moment to read our office policies.
This financial policy is to inform you of your financial obligation to our practice and intended to facilitate our ability to provide excellent service to you while minimizing our administrative costs. All charges you incur are your responsibility regardless of your insurance coverage. We must emphasize that as your dental care provider, our relationship is with you, our patient, not with your insurance company. Your insurance policy is an agreement between you, your employer, and the insurance company. Our practice is not a party to that agreement. If payment from your insurance company is not received within 60 days from the date of service, you will be expected to pay the balance in full. Any outstanding balance remaining on your account after 60 days will be charged, and you will be responsible for pursuing any outstanding insurance claims directly with your insurance company. Our office will provide you with any necessary information, claims or documentation required. We urge you to contact your insurance company to ensure prompt processing of such claims. Accounts over 90 days are subject to a 1.5% finance charge per month. Please note that we reserve the right to charge a $50 fee per child for all missed or broken appointments when not given a 24-hour notice. There is a $35 fee for all returned checks.
As a courtesy to our patients, we will generate and submit a claim to your insurance company on the day services are rendered. The office needs to be notified of any insurance changes at least 48 hours before all scheduled dental appointments for insurance verification purposes. If you cannot provide us with the necessary information, the balance will be due in full at the time services are rendered and we will generate a claim for you to submit to your insurance carrier for reimbursement purposes. Please note that you are responsible for your estimated copay at the time of service. Also note that our estimation of your insurance coverage is not a guarantee of payment, but merely an estimate based on the best information we have. There may be a deductible, a yearly maximum, fee schedules, benefits paid to other offices or other factors considered. Our practice accepts cash, personal checks, MasterCard, Visa, and Discover, American Express. A low and no-interest financing option through CareCredit financing is available upon request and approval. Please refer any questions or verification of precise benefits to your insurance company or employer.
As a courtesy to our patients, we will attempt to confirm your scheduled appointment. Feel free to leave a message on our 24-hour voicemail if you have any questions or concerns. However, once you have made an appointment, remembering and keeping it is your responsibility. Confirmation is simply a courtesy to you.
We make every effort to be on time; we hope you will also. Our office requires 24-hour notice for canceling or rescheduling any appointment. Please contact our office so that we may fill the open appointment spot with one of our many patients on a waiting list.
Failure to arrive on or before your designated check-in time may result in the rescheduling of your child’s appointment. Late arrivals cause delays in the day’s remaining schedule and cut into other patient’s appointment times.
**If you are 10 minutes past your appointment time, we will have to reschedule the patient’s appointment. **
As we realize that unforeseen circumstances may occur, we ask that if you find you are running late, please contact our office so that we may determine if the appointment can be held.
Our office policy is to dismiss patients from our practice who fail to attend two (2) appointments without calling in advance to cancel. Missing appointments is unfair to other patients who are in need of dental work and waiting for an appointment. This policy ensures we serve all our patients to the best of our ability and promptly.
Because we care about all of our patients in our practice, we offer an alternative to dismissal after two missed appointments. We can continue to see your child/children at Emerald Pediatric Dentistry on a “same day” appointment basis only.
After two missed appointments, your options are as follows:
- Option 1: Transfer your records to the dentist of your choice.
- Option 2: Schedule appointments on a “same day” only basis.
If you elect to stay with the practice as a “same day” patient, you will need to call the office to let us know you would like to remain an active patient. If you do not call your account, it will be switched to inactive. Once you call and are added to the “same day” list, we will then contact for an appointment.
To prevent dismissal or “same day” only scheduling please attend all of your scheduled appointments. If unforeseen circumstances arise and you are not able to attend, you must call at least 24 hours in advance to avoid the appointment counting as a “missed appointment.”
Under the HIPAA mandates and standards, we owe all of our patient’s privacy, security and courtesy. A device that can record, photograph and video this practice, staff and other patients are NOT ALLOWED past the waiting room.
Please understand that any estimate of your insurance benefits is solely an estimate and not a guarantee of payment and you are responsible for all charges whether or not paid by insurance.