Office Policies and Financial Agreement
It is our desire to provide the highest quality of dental care to everyone. The following is a statement of Toothworx’s Financial and Confidentiality Policies. We ask that you please read, agree to, and sign before any treatment is rendered.
Confidentiality and Taking/Receiving of Records
All information gathered at Toothworx regarding your care is kept confidential. I agree to the disclosure of my personal information including visual, written, oral, electronic, photographic or x-ray between any dentists that I am referred to and/or my medical doctors. I consent to the taking of photographs and x-rays by professionals at Toothworx as they are necessary for the diagnosis procedure and record keeping. I also consent to Toothworx receiving my dental records on my behalf from previous dental practices to ensure proper continuity of care.
Our goal is to maximize your insurance benefits. It is important to understand that the insurance contract is between the insurance company and you, the insured. Dental insurance was not designed to pay for all dental care. Treatment recommended by the dentist is never based on what your insurance company will or will not pay. Due to pending claims and patient privacy issues, we do not always know how much an insurance company has already paid out or the balance remaining on a yearly maximum.
Please be prepared to show your insurance card at the time of your visit. It is the patient’s responsibility to provide any new information regarding insurance. At the time of treatment the patient/guardian is responsible for the estimated portion the insurance does not cover (copay). If for some unforeseen reason your insurance carrier has denied or not made payment within 60 days, the patient/guardian is responsible for the balance in full.
If after 30 days the account is still outstanding, we will follow up with the insurance company. For those with no insurance, full payment is requested at the time of service. If after 30 days the account is still outstanding, finance charges will be applied to your account and the client will be responsible for these charges. After 90 days your account will be submitted to the Bermuda Credit Association for collection, with an additional surcharge added to the account to cover costs for collection. This percentage is dependent of how long the account is in arrears.
You will also be dismissed from our practice at that time.
Cancellations and Missed Appointments
The entire team here at Toothworx makes every effort to accommodate you and your busy schedule. If you are unable to keep an appointment, we ask that you kindly provide us with minimum of two‐business days’ notice. Our office does not accept cancellation or changes to appointments after hours by voice mail; you must call during our normal business hours. This courtesy on your part will make it possible to give your appointment to another patient who needs to see the dentist or hygienist.
Monday and Tuesday 8:40am-5:00pm
Friday – 8:40am-2:00pm
I have read, understand and agree to the above Office Policies and Financial Agreements.