Payment is due at the time service is provided. Our office accepts all major credit cards, cash, personal checks and CareCredit. Outside financing is available upon request and approval. As a condition of treatment by this office, financial arrangements must be made in advance. The practice depends upon reimbursement from patients for the costs incurred in their care.
Dental Insurance: Patients with dental insurance understand that all dental services are charged directly to the patient and that he or she is personally responsible for payment of all dental services. Elevated Dental can provide insurance ESTIMATES but CANNOT guarantee what insurance will or will not cover. Insurance coverage is an agreement between the insurance company and the patient. This office will submit claims on behalf of the patient, assist in making collections from insurance companies and will credit any collections to the patient's account. However, this dental office cannot render services on the assumption that our charges will be paid by an insurance company.
This policy gives permission for the insurance company to pay any insurance benefits rendered directly to Elevated Dental. This policy also authorizes Elevated Dental to release all information necessary to secure the payment of benefits and permits Elevated Dental's use of my electronic signature on my insurance submissions.
THE PATIENT IS FINANCIALLY RESPONSIBLE FOR ALL CHARGES NOT COVERED BY INSURANCE.
Past Due Accounts: Unless a prior agreement has been approved in writing by our office, the balance on your statement is due and payable when the statement is issued. If a past due account is not paid within thirty (60) days of the statement date, then a
$50.00 late fee may be charged on any account. If necessary, accounts that are not paid within ninety (90) days may be sent to collection agency.
Deposit Policy: Due to the extensive amount of time our staff and doctor devotes to preparing and reserving uninterrupted time for appointments over 2 hours, we may require a deposit equivalent to half of the treatment fee prior to scheduling the appointment.
Cancellation/Rescheduling Policy: Our practice is dedicated to quality care and exceptional service. Our doctors and team spend extensive amounts of time preparing for your visit. Broken and missed appointments create scheduling problems for our team, as well as other clients. If you find that you must change your appointment, we require a minimum of 24 hour notice, so that we may make every effort to accommodate other clients. If proper notice is not received or an appointment is missed without prior notification, a fee of $75.00 per hour scheduled may be charged to account for violation of this policy.