Financial Policy

It is the intention of all personnel in this office to provide for your oral surgical health needs as thoroughly and as
efficiently as possible. If at any time you have questions regarding any treatment, fee or service, please discuss them with
us promptly and frankly. We will make every effort to avoid a misunderstanding, to rectify an injustice, or to preserve a
friendship.

FINANCIAL ARRANGEMENTS

There are several methods of payment available. In order that we may have a definite understanding regarding the
payment of fees, please choose one of the following:

  • CASH PAYMENTS: Payment for dental services can be paid for at each appointment by cash or personal check.
  • CREDIT CARDS: We accept Mastercard, Visa, or Discover.
  • CareCredit or CITI Healthcare are accepted

Copayments are due at the time of service.

REFERRALS

If your medical insurance requires a referral, please bring that referral at the time of your appointment. If you neglect to
bring a referral, you will be requested to sign a waiver stating that you will get a referral from your primary care physician
or you will be responsible for any charges for that appointment.

INSURANCE

To avoid disappointment, we strongly suggest that patients contact their insurance company to make certain their dental
insurance assumptions are correct. As you know, most insurance companies pay only a portion of the dental charges.
Furthermore, patients must realize that professional services are rendered to a person, not to an insurance company.
Therefore, the insurance company is responsible to the patient and the patient is responsible to us. All patient amounts
are estimates. You should check with your insurance to verify maximum amounts, allowable and deductibles. Your insur-
ance benefits are your responsibility. There are different allowable amounts and deductibles. All estimates are based on
80-20% but your insurance may be different and not pay 80% of the charges. We will try to help you in any way possible
with your insurance.

We do not participate with all insurances. However, if we do not participate with your insurance, we will print out an
insurance claim form for you to submit for reimbursement. Also, pre-treatment estimates for more extensive dental care are
available. Your insurance will provide us with the amount that they will cover in advance of treatment. We will then
determine your estimated co-payment portion.

APPOINTMENT CANCELLATIONS

If you have to reschedule your appointment, please notify us 24 hours prior to your appointment.

If you are having problems making payments for scheduled procedures, please speak to our Billing Coordinator regarding
the Dental Fee Plan prior to the procedure.

If you have questions regarding your account, please contact us at Milford Office Phone Number 508-473-7900.