Patients with Dental Insurance:
As a courtesy to you, our office will gladly submit to your insurance. We are able to bill to all traditional, indemnity insurance plans. We do not accept DMO or DPO plans (Dental Maintenance or Dental Provider Organizations). Under these plans, there is no coverage when treatment is rendered by a non-participating dentist. Please check your type of plan carefully. For all PPO plans, even though Dr. Williams is out-of-network, we are still able to bill your insurance and benefits are payable. For more specific information about out-of-network benefit amounts,please call your insurance company.
We accept cash, check, VISA, MasterCard, Discover, and CareCredit. Payment of your “estimated” portion is due at the time services are rendered, such as your annual deductible and/or percentage of the treatment not covered by insurance. As a courtesy, we will gladly contact your insurance in order to provide an “estimate” of your patient portion. However, despite this, we cannot guarantee the payment of insurance benefits nor can we provide 100% accuracy of this estimated amount since many factors are involved that determine the actual payment of benefits once submitted and processed by your insurance. Keep in mind that many insurance companies base their quoted percentage of coverage (i.e. 100%, 80%, 50%, ect.) on their own fee schedule, and not our office’s actual fees, which may result in a balance due higher than expected. Should an outstanding balance due result after your insurance company processes your claim, you will then be sent a statement. Payment in full is due by the due date printed on the statement. Our office policy does not allow partial payments. If a credit balance should result after insurance processes your claim, a refund will be promptly issued to you.
Unpaid Insurance Claims:
All dental services rendered, whether or not covered by insurance, are ultimately the financial responsibility of the account holder. We will give your insurance company 60 days to remit payment. If there is still no payment after this time, in order to keep your account current, you will be financially responsible for 100% of the outstanding insurance claim. A statement will be sent to you, and payment in full will be due on the due date printed on the statement. It is the responsibility of the account holder to follow up with their own insurance company regarding the non-payment of a claim. Should our office eventually receive a payment from your insurance after it has been paid by you, a prompt refund will be issued.
If payment is not received by the due date printed on the statement, then your account is considered “past due”. We reserve the right to charge a $5.00 per month billing charge on all past due accounts. If the balance is still unpaid after 90 days, the patient(s) associated with the account may be dismissed as a patient from the practice and no further services shall be rendered without payment of the outstanding balance.
Patients without Dental Insurance:
Payment in full is expected at the time services are rendered. We accept cash, check, VISA, MasterCard, Discover and CareCredit. If, however, payment is made with cash or certified/cashier checks, a 5% discount is provided. We are unable to provide this discount if payment is made with a credit card.
We request at least 24 hours’ notice before cancelling or rescheduling an appointment. That way, we have some time to try and fill the opening left in our schedule. A missed appointment and last minute cancelation are viewed alike. We reserve the right to charge your account $35 if we are not notified at least 24 hours before your appointment. Two broken/missed appointments with out prior notification can result in dismissal from our practice. Thank you for assisting us in keeping our schedule full.
Dr. Williams reserves the right to update and make changes the above-stated office policies at any time without prior notification. By signing below I verify that I completely understand, agree, and accept the policies outlined above. I further acknowledge that I am responsible for all dental services rendered me and my dependents (if applicable).