Our Dental Policy

DEWEY STREET DENTAL FINANCIAL AGREEMENT

It is our goal for our patients to understand their treatment needs as well as their financial responsibility before treatment begins.  It is our desire to make dental treatment affordable to all of our patients.  Please review the following policies and procedures.

PAYMENT POLICY:  Payment is due at the time services are rendered unless prior arrangements have been made.  If you have insurance, we will send you a balance statement after insurance has paid their portion.

1. We accept cash, personal checks with proper ID, money orders, Debit cards, Visa, Mastercard, or Discover.
2. If there is a balance and the charges have been on the account for over 90 days, then an interest charge will be assessed at 1.5% per month or 18% per year finance charge on the unpaid balance until paid in full.
3. If your account becomes delinquent and given to a collection agency, you will be responsible for any costs incurred in the collection of your debt (i.e. collection agency fees, court fees, and attorney fees).
4. Fees will apply for any check that is returned by the bank. It is YOUR responsibility
5. MINOR PATIENTS: In the case of divorced or separated parents, it is YOUR responsibility to have financial arrangements made according to the divorce decree before dental treatment begins.

DENTAL INSURANCE:  As a courtesy we will gladly file your claims and accept assignment of dental insurance benefits provided you agree to the following:

1. You must provide us with an insurance card and/or all of the information necessary to verify your coverage and file your claim.
2. Your insurance policy is a contract between you, your employer, and the insurance company. We are NOT a party to that contract.
3. You are responsible for all treatment charges, even if they differ from what your insurance company allows. The exception is if we are an “in network” provider and usual and customary rules apply.
4. We will provide you with a written estimate and prior authorization with your insurance company prior to treatment (except emergency care) to the best of our ability. Knowledge of your benefits, limitations, exclusions, waiting periods, etc. is YOUR   Unforeseen treatment needs or change in the course of treatment is an inherent risk in healthcare.  We will do our best to keep you informed of any changes during treatment and associated costs.  However, you will be responsible for any charges incurred as a result of treatment changes.  Receiving our services indicates your acceptance of responsibility to pay.
5. Charges not paid by your insurance company are your responsibility regardless of the reason for nonpayment. Not all services we provide are covered benefits.  Benefits differ from one company or plan to another.   Fees for non-covered services, along with deductibles and copayments, are due at the time of service unless prior arrangements have been made.
6. Treatment provided in another dental office during your current plan year may alter your co-payment due for services in our office. We are not able to track whether or not you have reached your yearly maximum benefits.  Please call your insurance company if this applies to you.
7. There are many factors in determining patient responsibility where the coordination of benefits between two insurance companies are involved. We will provide you with the most accurate information available to us, but CANNOT guarantee what your out-of-pocket expense will be.
8. Please understand that our responsibility is to provide you with treatment that best meets your needs, and not to try to match your care to insurance plan limitations.

BROKEN OR MISSED APPOINTMENTS:   To reschedule or cancel an appointment, please notify us at least 24 hours in advance.  Missed or broken appointments prevent others from receiving the dental care they deserve.  We reserve the right to terminate professional treatment of any patient when scheduled appointments are not kept.