Financial Information

At this office, we follow the guidelines of the American Academy of Pediatric Dentistry with regard to frequency of X‐rays, cleanings, fluoride treatment, and restorative care.

As a specialist, Dr. Verhagen regards these guidelines as the standard of care (best treatment for your child). These guidelines are not dictated by dental insurance, and it is your responsibility to understand whether your particular insurance plan will reimburse you for these services. Please speak with your insurance company or employer with questions about limitations and frequencies.

Payment

Payment is expected in full for each appointment when services are rendered. Payment options are:

  • Cash
  • Check
  • Credit card (Visa, MasterCard, Discover)
  • CareCredit (Interest‐free special financing on approved credit)

No appointment will be made until the balance is paid in full.

Dental Insurance

Insurance is a contract between you and your insurance company. There is no direct relationship between our office and your insurance company.

Your insurance benefits are determined by the type and design of the plan chosen by you and/or your employer; we are not a party to this contract. We have no control over the terms of your contract, the method of reimbursement, or the determination of your benefits.

Some and perhaps all of their services may be defined by your insurance company as “not covered,” “denied,” or “over UCR.” We will file your primary and secondary insurance claims as a courtesy to you. We do not guarantee payment and are not responsible for providing you with the plan limitations, exclusions, and provisions determined by your insurance company.

You agree to pay any portion of the charges not covered by your insurance. If your insurance company requires a referral and/or preauthorization, you are responsible for obtaining it. We will file a pre‐determination for recommended treatment when you request it.

Emergency / After Hours Appointment

If your child is seen for an emergency visit after our regular business hours, an emergency visit fee is charged in addition to any treatment on that visit.

Returned Checks

There is a fee of $35.00 for any checks returned by the bank for insufficient funds.

Monthly Statement

If you have a balance on your account, we will send you a monthly statement. It will show the previous balance, any new charges to your account, and any payments or credits applied to your account during the month.

Professional fees are the responsibility of the parent or guardian authorizing treatment; we cannot send statements to other persons.

Past Due Accounts

If your account becomes seriously past due, we will take necessary steps to collect this debt. This may include sending your account to a collection agency or small‐claims court.

Divorce

In case of divorce or separation, the responsible party prior to the divorce or separation remains responsible for the account. If the divorce decree requires the other parent to pay all or part of the treatment cost, it is the authorizing parent’s responsibility to collect from the other parent.

Questions

If you have unusual circumstances and would like to make special arrangements to pay your account, we encourage you to contact us. We are not unreasonable and would like to work with you. Lack of any payment or communication can be interpreted as refusal of payment.

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