AESTHETIC DENTAL ARTS, PC Written Financial Policy

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Information about AESTHETIC DENTAL ARTS, PC Written Financial Policy
Health & Medicine

Published on June 19, 2014

Author: AestheticDentalArtsPC

Source: slideshare.net

Description

At Aesthetic Dental Arts, we bring the comforts of our spa-like atmosphere directly to your smile. Enjoy excellent, full-service dental treatmentranging from routine check-ups to the latest in cosmetic dentistry in the relaxing environment of our state-of-the-art high tech office.

Thank you for choosing Aesthetic Dental Arts PC. Our primary mission is to deliver the best and most comprehensive dental care available. Your clear understanding of our Financial Policy is important to our professional relationship. PAYMENT OPTIONS You may choose any one of the following. • Cash, Check, Visa, Master Card, American Express or Discover Card. • We offer a 7% accounting adjustment to patients without insurance who pre-pay their dental services by cash, check or credit card in full at least 48 hours prior to the start of treatment. • A 5% courtesy adjustment is offered to patients without insurance who pay for their treatment by cash, check or credit card in full on the date of service. • Patients aged 62 and older without insurance are eligible for a 10% senior discount when they pay their dental treatment in full by cash, check or credit card at the time of service. • No Interest Payment Plans from Care Credit or CitiHealth Card (Subject to Credit Approval). Please Note: Insurance is a contract between you and your insurance company. For patients with dental insurance, we are happy to work with your carrier to maximize your benefit and directly bill them for reimbursement for your treatment. However, our contact is with you- not your insurance company. Our staff cannot be responsible for reimbursement for knowing all the terms and limitations of the many policies of our patients. It is your responsibility to familiarize yourself with your dental care policy and beware of any uncovered charges or limitations of your plan. Aesthetic Dental Arts PC requires payment at the start of your treatment. Please be prepared to pay you deductible and any estimated amount not covered by your insurance plan at the time of your visit. Payment in full is required for all dental plans who reimburse the subscriber directly. For larger, more comprehensive treatment plans of $500 or more, a 50% deposit may be required to secure your initial treatment appointment. If you choose to discontinue care before treatment is complete, your refund will be determined upon review of your case. For plans requiring multiple appointments, alternative payment arrangements may be provided. Our office requires 2 business days notice to change or cancel an appointment. We reserve the right to charge for each broken/missed appointment. Aesthetic Dental Arts, PC assesses a charge for all non-sufficient funds checks. We reserve the right to transfer any credit balance to other family members with outstanding accounts. Patients are responsible for all charges whether or not paid by insurance. Unpaid balances over 90 days will be processes through a collection service and the patient will be responsible for any additional collection charges. I have read and fully understand the above financial policy. Written Financial PolicyAESTHETIC DENTAL ARTS, PC

Patient, Parent or Guardian Signature Patient Name (Please Print) Date If you have any question, please do not hesitate to ask. We are here to help you get the dentistry you wand and need. ADA, PC Rev 8/09

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