Financial Policy2

Comprehensive Family Dentistry

With An Emphasis on Gentle Care & Prevention

Financial Policies

We pride ourselves in the high level of care we provide to all our patients. In order to continue this, we have developed the following financial policies

Payment

Þ Payment is expected at the time services are rendered

Þ We accept cash, cheque, Interac, Visa and Mastercard.

Þ We offer financing for some or all of your dental workthrough either Medicard or CareCredit Financing companies. If you are interested, an application for credit can be completed in our office .

Þ Any other payment arrangements must be made with Susan our Treatment Coordinator in advance of your appointment.

Dental Benefits

Þ We will submit insurance claims electronically on your behalf . If your insurance company does not accept claims electronically , an insurance form will be given to you for your submission by mail.

Þ Provided your insurance information is accurate and depending on your insurance company., your payment should be received within one to two weeks,

Þ It is your responsibility to provide us with accurate insurance plan information and inform us when there are any changes to it. Please bring in your insurance booklet.

Þ We will submit a pre-authorization to your insurance company to determine your dental benefits before beginning major treatment.

Information for patients with Dental Benefits

§ Your dental benefits are a contract between you, the insurance company and your employer, not the dentist. We are not affiliated with any insurance company.

§ Our concern is for your dental health. We always recommend treatment that best suits your individual needs regardless of your insurance coverage.

§ Most Dental benefits plans do not cover 100% of your needed dentistry. Some companies offer 100% percent coverage of a prior years fee guide. We are charging current fees, which are based on our clinical expertise, quality of care and materials.

§ Insurance companies are changing policies frequently. They do not inform dental offices of these changes. Please inform us of any changes to your coverage otherwise we have no other way of knowing.

Information we need about your plan:

1. Yearly Maximum ___________$

2. Yearly deductible ___________$

3. Fee guide used? _____________

4. What is the calendar year? Or is it Rolling ? ____________

5. Is there crown and bridge coverage? Yes No

6. Is there denture coverage? Yes No

7. If applicable- how often can dentures be replaced?_______

8. Is there ortho coverage? Yes No, Lifetime Max? _______$

9. What percentage does your plan cover?

10. Basic work:________ % Major Work_______%

11. Are recall every six or nine months? ______________

12. How many units of scaling are covered per year? ______u

INSURANCE TERMS YOU NEED TO KNOW

Annual Maximum- Most insurance companies have an annual maximum amount of coverage for each patient listed under the insurance policy. This coverage may be changed and patients may not be informed.

Deductible - The dollar amount the patient pays toward their treatment total before insurance coverage begins.

Eligibility- determines who is covered under the insurance policy.

Exclusions - Many dental services and treatments that are clinically necessary are not covered by dental insurance. These exclusions are usually described in the patient's insurance booklet, but be aware that more treatments are being excluded to reduce costs.

Co-payment or "Out of Pocket Portions" -are part of the treatment fee not covered by dental insurance. The insurance company will pay a certain percentage of the treatment, but they rarely cover 100%

Dual coverage -is when both spouses are covered by different insurance plans. The insurance companies usually co-ordinate the benefits so that the patient does not receive more than 100% of the cost of treatment.

Assignment - of insurance is when a patient signs a section of the insurance form, which allows the dentist to receive payment directly from the insurance company. Insurance companies now often send payment to the patient. This should be forwarded to the dentist as soon as possible.

Special Privacy Information