DENTAL INSURANCE COVERAGE NOTICE AND DISCLAIMER
Lakeside Dental Arts and their associates are committed to helping patients with their dental insurance.
1. My dental insurance coverage is a contract between the insurance company and myself.
2. My coverage is determined by my choice of dental insurance plan. Lakeside Dental Arts and their associates have no involvement with the insurance company fee allowances or payments.
3. My dental insurance is not Lakeside Dental Arts’s responsibility. The practice will file my insurance as a courtesy to me. Lakeside Dental Arts is not responsible for delays in payment or determinations of coverage.
4. I understand my dental insurance company may not communicate with Lakeside Dental Arts. I may need to contact Lakeside Dental Arts to inform them of any dental insurance issues.
5. Lakeside Dental Arts and their associates cannot make ANY representation of warranty that my dental insurance company will cover all or any portion of the dental services provided.
6. I understand it is my sole responsibility for payment of services regardless of my dental insurance coverage.
After reading this Notice and Disclaimer concerning my dental insurance coverage, I understand and agree to the terms and conditions above.