Office Policy

Payment will be expected at the time of service for all non-contracted fees and co pays.

Insurance contracts: If we have a "Participating Contract" with your Insurance carrier, we will accept assignment on all Covered Services and bill your Carrier for you. You are responsible for the Co pay, Coinsurance, and Deductible and for all non-covered services.

Insurance plans represent a contract between yourself and the insurance company. These contracts are not between the doctor and the Insurance Company. We will do our best to help you obtain benefits, but we cannot be responsible if your Carrier does not pay. Further, if a member of our staff advises you that you are fully covered or implies that you will owe nothing, it is your responsibility to contact your insurance company for verification. Therefore, it is your responsibility to make certain your carrier makes prompt payment, and to handle any disputes that may arise.

If your insurance has not paid the FULL BALANCE within 45 days from the date of service, you are asked to pay the balance in full. A finance charge of 27.99% APR (2.33% a month) or $29.00 which ever is greater will be added to the total balance on all accounts over 60 days past due.

Third party financing may be available for patients requiring extensive treatment ($500 or more) through Capital One/Unicorn. This type of financing must be approved in advance. The terms of this contract consist of 12 to 18 equal installments, free of interest or finance charges. The total financed amount however, must be paid in full within the terms of the agreement.

If at any time you have questions regarding any treatment, fees, or services, 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.

Missed appointments: Our policy is to charge for missed appointments unless a cancellation is received at least 24 hours in advance. The charge is $50 per hour of scheduled time in General Dentistry and $100 in Endodontics and Surgery.

Children in the office: Please make arrangements for your non-scheduled children prior to your visit. Children should not be left unattended in the reception area. All children 17 years of age and under, scheduled for treatment must have a parent or legal guardian present in the office during their appointment.

Cellular phones/pagers: We request all cellular phones and pagers be turned off or to silent mode during your appointment.

Family/Friends: In order to comply with regulations set by our office, and for the safety and comfort of our patients and employees, no friends or family members will be permitted to accompany patients in the treatment area during the appointment. Any patients with special needs can make necessary arrangements with the office manager prior to your appointment.

We reserve the right to dismiss any patient from our practice for inappropriate behavior in our office or on the phone.

I have read the policies and agree with the terms outlined above.

I acknowledge that I am responsible to pay all charges for treatment administered by Smiles of America as outlined above.