Dentex Dental Specialty Group Office Policies

GENERAL POLICIES •

Appointment Confirmations: Dentex Dental Specialty Group encourages patients to confirm all appointments with the front office staff via phone, e-mail, or text message communication. We always aim to accommodate patients with unconfirmed appointments, but patients with unconfirmed appointments may experience longer wait times or be asked to reschedule the appointment.

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Electronic Communication: Dentex Dental Specialty Group encourages patients to utilize electronic communication including e-mail and text messages to confirm appointments and make other needed inquiries.

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After-hours and Weekend Appointments: Dentex Dental Specialty Group offers afterhours and weekend appointments. After-hours consists of appointments after 5 p.m.

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Walk-in Appointments: Dentex Dental Specialty Group encourages walk-in appointments, but additional wait time may be required.

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Missed Appointments: A missed appointment fee of $40 will be charged if the office is not notified more than 24 hours in advance. The fee is not covered by insurance and will not be billed to insurance.

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Specialist Appointments: A deposit of $250 is required to be added to a specialist schedule. This includes endodontics, periodontics, oral surgery, and other general appointments scheduled for more than two hours. The deposit will be applied towards the cost of treatment. The deposit is only refundable if the appointment change is made two weeks or more in advance. You will be asked to pay the total fee two weeks before the appointment to confirm and reserve the appointment time. For specialty appointments booked less than two weeks before the procedure, the total fee is due at the time of scheduling.

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Copy of Medical Records: A written request must be received before the release of each medical record. E-mailed records will be released at no charge, while a $40 fee is required for hard copies of medical records. Please allow two weeks from the receipt of the request.

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Authorization to Treat Minors: Dentex Dental Specialty Group will be unable to treat a minor (17-years-old and younger) without a parent or legal guardian present. A minor may be treated in the presence of an adult other than the parent or legal guardian without proper written consent.

Outstanding Balances for any and all family members are due and payable prior to the next appointment.

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Copayments and Deductibles are estimated according to your policy coverage.

Payment for non-covered services or services for which eligibility/coverage can not be confirmed is due at the time of service.

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Payments are due at the time of service.

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FINANCIAL POLICIES

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Collection Policy: If payment is not made at the time the monthly billing statement is received, you may be responsible for interest/penalties. Dentex Dental Specialty Group subscribes to a collection agency for any unpaid debt. Once your bill goes to collections you will be responsible for attorney fees, interest, and penalties. Dentex Dental Specialty Group cannot pull an account out of collections once it is sent to collections. If your account is sent to collections you will be discharged from the practice.

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Financial Hardship: If you encounter financial hardship, Dentex Dental Specialty Group has a policy for payment programs. Financial hardship qualifications are required to be met prior to payment arrangements.

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Returned Checks: There will be a $35 returned check fee applied to your bill for any returned check. This is the charge we incur from our bank.

INSURANCE POLICIES •

Coverage Terms: Your insurance is a contract between you and your insurance company. You are responsible for knowing the terms of your insurance policy. It is not the responsibility of Dentex Dental to know your policy details. Dentex Dental attempts to verify eligibility and benefits, however, we are unable to guarantee benefits of payment until insurance claims are processed.

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Billing Policy: Your insurance company will be billed on the date of service. When the Explanation of Benefits (EOB) is received for the date of service, your account will be credited for payments beyond your responsibility. If coverage is denied or there is a remaining patient responsibility, you will be responsible for payment in full. You will be billed monthly.

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Insurance Company Disputes: It is your responsibility to negotiate payments with your insurance company.

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Preferred Provider Organization (PPO) In Network Insurance Disclosure ▪

We are a participating provider with Delta Dental. We have providers in both the PPO and Premier Networks. As a contracted provider with Delta Dental, we have agreed to provide dental services with some negotiated rates.

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The benefits of utilizing in-network providers with your insurance are: You may pay less out-of-pocket because fees are pre-established with the insurance company

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You may get more coverage and more benefits at the time of service

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Prices may be lower with a participating provider

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At the time of service, we rely on several methods to determine your insurance coverage and associated out-of-pocket fees. This includes predetermined fee schedules, online benefit verification, and phone benefit verification. In some cases, these benefits are estimated, either by our staff or by representatives of your insurance company. Benefits are not guaranteed until your insurance company has reviewed, processed, and finalized your claim payment. After your insurance processes your claim, you may owe an additional sum to our office, based on the terms of our contract with your insurance company.

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Out of Network Insurance Disclosure ▪

Many of our dentists are non-participating providers. While we are a nonparticipating provider with your benefit plan, we still accept your insurance as coverage for your services.

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The benefits of choosing a non-participating provider include:

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You can select a dentist who suits your needs and has expertise in the field

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You avoid the risk of getting low-quality dental treatments because you are limited to providers your insurance refers you to

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Your out-of-pocket fees may be lower because your insurance provides a higher reimbursement rate for services

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You have greater flexibility because we are not subjected to a predetermined contract with your insurance company

After your services, you may receive an Explanation of Benefits from your insurance. This will display the procedures performed at your visit and the fees billed to your insurance company. It will also show your plan coverage and the amount paid for your services. THIS DOCUMENT FROM YOUR INSURANCE IS NOT A BILL. Any additional billing statements will come directly from our office.

Health Maintenance Organization (HMO): Dentex Dental Specialty Group does not participate in any HMO programs. If you are a member of an HMO policy and are being seen in our office, payment in full is due at the time of service. It is not the responsibility of Dentex Dental Specialty Group to know what type of insurance program you participate in.

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