WRITTEN FINANCIAL POLICY & PAYMENT OPTIONS

PAYMENT OPTIONS: PLEASE NOTE THAT PAYMENT OF ALL TREATMENT FEES ARE SOLELY THE RESPONSIBILITY OF YOU, THE PATIENT OR GUARDIAN.

OPTION A

Payment of total fee at first appointment of treatment. For patients that prefer to pay cash/check for their treatment, a 5% courtesy is allowed for total fees over $1,000.

OPTION B

We also Accept, Visa/Mastercard/Discovery/Amex

OPTION C

DSP. In-House Dental Savings Plan- $545 annual fee (renews yearly). This is not a Dental Insurance plan. Plans are non-refundable and unused benefits do not roll over to the next Year. (Additional Terms & Conditions supplied by practice). Cannot be combined with any other offer. 15% cash/check discount & 10% Credit Card Discount on additional treatment.

OPTION D

FFS: As a courtesy to our patients, an insurance claim will be submitted for services rendered, however we expect a minimum of 50% plus your deductible at time of treatment.
Any balance above your annual maximum insurance benefits is also due at time of service.

Contracted Insurance: For patients with dental insurance, we are happy to work with your carrier to maximize your benefit and directly bill them for reimbursement for your treatment.
If any balance remains, it is solely your responsibility and must be paid within 2 months of the 1st day treatment. This will automatically be charged to your credit card if payment is not received.

OPTION E

Convenient Monthly Payment Option available through,

Allowing you to pay over time.

Pre-Qualify, NO impact to your credit score.
No interest if paid in full options.
No annual fees or pre-payment penalties.
*Subject to credit approval

Please note:
32 Dental Office requires payment prior to the completion of your treatment. THIRD PARTY COVERAGE: We will be happy to accept payment from your primary insurance company after a pre-estimate has been received. You may start treatment with one of the above plans and adjust your balance when the pre-estimate is returned. PLEASE NOTE THAT YOU ARE RESPONSIBLE FOR THE PAYMENT OF FEES IF THE TOTAL INSURANCE PAYMENT IS NOT RECEIVED WITHIN 60 DAYS. We will do our best to help you with insurance problems. However, you need to realize that your insurance company is contracted between you, your employer and the insurance company, and they are the ones who decide your eligibility for coverage. The insurance company will pay for the different dental procedures based on the contract that was negotiated by the insurance company and your employer- not this office.

UNDERSTAND THE PROPOSED TREATMENT PLAN AND CHOOSE PAYMENT PLAN: A B C D
FEES QUOTED ARE GOOD FOR 90 DAYS FROM TODAYS DATE.

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