OUR FINANCIAL POLICY
Thank you or choosing us as your health care provider. We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our Financial Policy, which we require you to read and sign prior to any treatment.
All patients must complete our Information and Insurance Intake Form before seeing the doctor.
PAYMENT IS DUE AT THE TIME OF SERVICE
WE ACCEPT CASH, CHECKS, VISA, MASTERCARD AND AMEX
Your insurance policy is a contract between you and your insurance carrier. We are not a party to that contract. As a courtesy, we will submit a claim to your insurance carrier on your behalf. Because this is never a guarantee of payment, we require all payments to be made at the time of service.
Please be aware that some, and perhaps all, of the services provided may be non-covered services and not considered reasonable and necessary under your medical insurance.
MEDICARE & MEDICAID DO NOT COVER THESE PROCEDURES.
Usual and Customary Rates
Our practice is committed to providing the best treatment for our patients and we charge what is usual and customary for our area. You are responsible for payment regardless of any insurance company’s arbitrary determination of usual and customary rates.
The adults accompanying a minor and the parents (or guardians of the minor) are responsible for full payment. For unaccompanied minors, non-emergency treatment will be denied unless charges can be made by cash, check, Visa, MasterCard or American Express at the time service has been verified.
Unless canceled, at least 24 hours in advance, our policy is to charge for missed appointments at the rate of a normal office visit. Please help us serve you better by keeping scheduled appointments.