Practice Disclaimer

Payment
There is normally some form of payment due for each and every visit.

  1. All patients are required to pay an OSHA (Occupational Safety Hazard Association)
  2. If you are a member of a PPO insurance, a co-payment is required for each procedure and/ or treatment. This is determined by a percentage that is established by your insurance carrier.
    NOTE: if for some reason your insurance carrier does not pay the balance in full, you the patient are responsible for the balance on your account. Often, you will receive an Explanation of Benefits (EOB) from your insurance company showing what is paid and what your responsibility is.
  3. If you are a member of an HMO, you receive a discounted rate for each procedures and/ or treatment. Your insurance carrier determines the discount you receive.

NOTE: Primary insurance is the insurance is the insurance that is initially presented to this office. Supplemental insurance will not be accepted until after the benefits of the Primary insurance have been utilized.

FIRST/INITIAL VISIT CLASSIFICATION

Routine check-ups & Cleanings
Preliminary x-rays are taken, a comprehensive oral examination, *prophylaxis, and fluoride rinse are performed and a treatment plan is advised. *If determined during the comprehensive oral evaluation that a more extensive cleaning (full mouth debridement) is warranted, the provider must perform this treatment prior to proceeding with any recommended treatment plan. Basic cleaning or prophylaxis is performed on patients who have maintained good oral hygiene habits. If the provider determines that a basic cleaning is not appropriate, he/she will explain why and will follow through with your treatment plan. If you desire additional procedures to be performed, you may make a request and the Doctor will determine whether there is time available or if you need to be scheduled to come back.

Emergency Visits
Initial exam/interview, appropriate X-rays, discuss treatment options, coordinate with the Patient Care Coordinator your insurance coverage and/or method of payment. Perform discussed treatment and schedule additional appointments as needed.

Focus Visit
Initial exam/interview, appropriate x-rays, discuss treatment options, coordinate with the Patient Care Coordinator insurance coverage and/ or method of payment. Perform discussed treatment and schedule additional appointments as needed.