Financial Policy

If you have PPO dental insurance and benefit coverage has been verified, we will accept assignment and file the insurance claim on your behalf. You are required to pay the patient portion we estimate your insurance will not cover, including deductibles, at the time of treatment. 

While we do our best to estimate the expected amount your insurance will cover, we do not know for certain what your insurance will cover so we collect the estimated patient portion at time of service. We do not know how much your insurance will cover because our office is out of network and dental insurers will not share their out of network reimbursement fee schedules with out of network dentists. Therefore, we will file your claim with your PPO insurance and await payment and you are responsible for any balance that might remain after the dental insurance has paid the claims.

  • The parent/guardian/family member bringing the child to the appt is responsible for paying the patient portion and must have a method of payment with them at the appointment.
  • Our office does not call spouses, ex-spouses, family members or any other 3rd party to obtain payment. 
  • We accept cash, check, MasterCard, Visa and Discover credit cards but not AmEx.
  • For patients without insurance we recommend exploring payment options with or and applying for credit on their website before scheduling any treatment.
  • Please be advised that the policy of this office is to charge $50.00 for a missed appointment unless canceled by contacting our office at least 2 business days prior to their appointment as we have other patients on waiting lists and require adequate lead time to schedule them into any earlier times that may become available.
  • Accounts with balances 90 days or more past due will be assessed late fees. Unpaid balances that are 120 days or more past due will be assessed a late fee and then be submitted to a 3rd party medical collections service and collection fees up to 15% of the unpaid balance will be assessed and all credit bureaus will be notified.
  • Once submitted for collections the patient accounts are inactivated and no longer a patient of the practice.

Our New Patient Forms contain our Financial Policy agreement which parent(s) are required to sign as part of our agreement to treat your child.