2022 Isaacs Family Dental Office Policies
I hereby guarantee payment in full of any and all fees in consideration for dental services I am responsible for. I understand that I am responsible for all fees not covered by my dental insurance including deductibles and co-payments. I understand payment is due in full for those fees at the time service is performed.
As a courtesy, we contact your dental insurance provider to check your benefits and submit claims on your behalf. We are not responsible for and can make no guarantees as to the coverage your dental insurance will provide. As the patient, it is ultimately your responsibility to know your dental insurance and benefits and you are responsible for any balance that is not paid by dental insurance. We require that all patients, with or without insurance, pay for their treatment at the time of service. We will be happy to file a pre-determination prior to any treatment to your insurance so we can get more of an accurate estimate of what they should pay, but it is still not a guarantee of their payment.
* We accept any major credit card such as American Express and Discover, cash, check. If your advised treatment creates a financial problem on your part, companies like Care Credit (6 months no interest) and Lending Club (12 months no interest) are able to give you affordable payments. We do not have in-office payment plans besides through these companies.
* In an effort to control the cost of our dental fees, we do require a 24 HOUR NOTICE to change or cancel a scheduled appointment. This charge of $30 per hour for hygiene and $50 per hour you were scheduled with the doctor that will automatically be applied to your account. We give out appointment cards, send out texts and e-mails, and call to confirm. You must speak to a staff member to cancel any appointment. We do not accept cancellations via text or e-mail.
* We pride ourselves for being on time for your appointment and we ask that you do the same for us. Arriving 15 or more minutes late could result in having to reschedule. More than 3 failed appointments could result in dismissal.
* The office will charge $30 for a returned check. In the event of a returned check, we reserve the right to have you pay in cash for future visits.
* If the account is turned over for advanced collection services, the patient or responsible party will be expected to pay all collection fees (under $175, there is a $50 collection fee and $175 and over, there is a 30% collection fee), court costs, and reasonable attorney fees.
* Due to OSHA, HIPAA, and government regulations; patients and staff members are the only ones permitted in treatment rooms. You may escort someone back to get them situated but you will asked to wait in the lobby. Any consults/questions can be talked about after the treatment in our consult room.
* In order for you to be seen in our office, you must sign our office policies at the end of this form. You may ask for a copy of this form