Financial Policy & Agreement – Twin City Dental
Welcome to Twin City Dental. Our goal is to make sure you receive the highest quality dental care and service possible. We know that providing complete, comprehensive dental service includes discussing all treatment and financial information.
Payment for services, including deductibles and copayments, is due at the time of the service unless other arrangements have been made prior to treatment. Payments may be made using cash, check, or credit cards. Any arrangements for third-party financing must be made before starting treatment.
Insurance benefits are determined by your employer and/or insurance plan, not your dentist. Your insurance policy is a contract between you and your insurance company. Insurance is intended to cover some dental care costs, and is not a guarantee of payment. It often does not cover all the costs involved in treatment and not all services may be covered by your plan. Your insurance coverage, benefits and all treatment related charges are ultimately your responsibility.
As a courtesy, we will be happy to submit your insurance claim for you if you present your dental insurance card and all required employer information. We cannot guarantee that any coverage estimated by your plan will be paid once a claim is filed. In order to maximize your benefits, our office may refer you to your insurance carrier or your employer’s benefits coordinator for assistance in understanding your plan. You will be expected to pay for services rendered if this office is unable to verify your insurance information before treatment.
If payment for services already rendered has not been paid in full within 30 days, either by you or your insurance company, the remaining balance for your treatment is considered due and must be paid by you. You will be charged a 9% annual finance charge on any outstanding balance over 30 days.
Appointments are reserved exclusively for you. If you are unable to keep your scheduled appointment, we require at least 24 hours advanced notice. If an appointment is not rescheduled or canceled at least 24 hours in advance, or if you fail to keep your appointment, you will be charged a $50 fee. Any missed appointment 90 minutes or more in length will incur a $75 fee. This fee will not be covered by your insurance company.
Payment plans and financial arrangements may be available for comprehensive dental treatment. Please speak to us to make arrangements prior to commencing treatment.
I acknowledge that I have read, understand, and agree to this financial policy:
