SUBMISSION OF INSURANCE CLAIM FOR BENEFITS

Full payment at the time of services will be required in all cases in which verbal or written authorization from the insurance carrier cannot be obtained in a timely manner.

As a courtesy to our patients for fees related to actual treatment procedures, we will obtain an assignment of the insurance benefits from you at the time of service and then submit a claim for payment to your dental insurance carrier. If insurance coverage cannot be confirmed either by telephone, online or in writing prior to your appointment, full payment will be required at the time services are rendered,. Under such circumstances we will help you file your claim so that you will be reimbursed promptly. If insurance coverage is verified and services are authorized by your carrier prior to services being rendered, you will be required to tender payment for all uncovered expenses, co-payments and deductibles at the time of your appointment. If a claim for insurance benefits is filed on the patient's behalf and a balance occurs then after receipt of benefits, the patient agrees to immediately pay any outstanding balance upon notice of the same from either this office or the insurance carrier. Notice is effective upon mailing. This office reserves the right to require written authorization for insurance coverage prior to allowing acceptance of your insurance assignment. This office further reserves the right to decline any insurance assignment of rights and to require full payment directly from the patient.

A patient's insurance coverage is a contract between the patient and the insurance company. Any disputes in availability of coverage, coverage limitations, or any other matter related to your individual policy are solely the responsibility of the patient. A determination of benefits or verbal verification from you insurance claim is not binding and, does not guarantee accurate final coverage.

This office will not accept any assignment of rights to insurance benefits for any PPO policy or circumstances in which the provider may be considered "out-of-network". Under these circumstances, full payment will be required from the patient at the time of services and the patient can pursue reimbursement directly from their carrier.