Our office is committed to providing you with the best possible care. If you have dental insurance, we will help you to receive your maximum allowable benefits. In order to do this, we need your assistance and your understanding of our financial policy.
Payment for services is due at the time services are provided unless other payment arrangements have been approved in advance. We accept cash, check, and all major credit cards. We also offer interest free payment plans for six or twelve months through CareCredit. Extended payment plans are available, and we will be happy to discuss these options with you. If you have insurance, we will be happy to process your claim for you. Please be prepared to pay your estimated portion on the day of service. It is impossible for us to know all our patients' insurance coverage and additional payments may be necessary once your claim has been processed.
Returned checks will be subject to additional collection of $25.00.
We will gladly discuss your proposed treatment and answer any questions relating to your insurance. You must realize, however, that your insurance is a contract between you, your employer, and the insurance company. We are NOT a party to that contract. Dental insurance is not meant to be a pay-all: it's only meant to be an aid. Many routine dental services are not covered by dental insurance at all. If you should have any questions regarding your coverage, YOU could contact your insurance company. Your insurance will only pay up to your maximum amount allowed per benefit period.
We must emphasize that as dental care providers, our relationship is with you - NOT your insurance company. While the filing of all insurance claims is a courtesy we extend to our patients, ALL charges are YOUR responsibility.
If you have any questions about the above information or are uncertain regarding insurance information, please do not hesitate to ask us. We are here to help you.
ASSIGNMENT & RELEASE: I have read all the information on this sheet. I hereby authorize my insurance benefits to be paid directly to Dr. Lenderman and Lenderman & Meek Dental. I understand and agree that (regardless of my insurance), I am responsible for the balance on my account for any professional services rendered. In the event that the services of an attorney or collection agency is required to collect any portion of payment due for my dental services rendered, additional fees may be incurred. I understand and agree that I will be responsible for payment of all fees related to collection of my account including attorney fees, collections agency fees and court costs.