financial policy

Thank you for choosing us as your provider for dental services.  We are committed to your treatment being successful.  Please understand that payment of your bill is considered a part of your treatment and we are committed to your treatment being successful. The following is a statement of the financial policies of Dr. Craig Adams DMD, P.A., which we require you to read and sign prior to any initiating treatment.

All patients must complete our information and insurance form before seeing the doctor.

FULL PAYMENT IS DUE AT TIME OF SERVICE.
WE ACCEPT CASH, PERSONAL CHECKS AND MASTERCARD/VISA

In most cases we will accept assignment of your insurance benefits.  However, we do require your portion of the bill (also known as copayments) to be paid at time of service. The balance is your responsibility whether your insurance company pays or not.  We cannot bill your insurance company unless you give us your insurance information and a copy of your insurance card.  Your insurance policy is a contract between you and your insurance company.  We are not a party to that contract.  Please be aware that some, and perhaps all, of the services provided may be non-covered services and not considered reasonable and/or necessary under your insurance.

Usual and Customary Rates

Our practice is committed to providing the best treatment for our patients and we charge what we feel is a fair fee for the services rendered.  You are responsible for payments regardless of any insurance company’s arbitrary determination of usual and customary rates.

The adult, parents or guardian accompanying a minor are responsible for full payment of services.  For unaccompanied minors, non-emergency treatment will be denied unless charges have been pre-authorized to an approved credit plan, Visa, MasterCard or payment by cash or check at time of service has been verified.

Missed Appointments

We understand that schedules sometimes change with short notice, but we would like the courtesy of 24 hours notice if you need to cancel an appointment.  We reserve the right to charge $50.00 to $l00.00 per hour for missed/broken appointments when 24 hours notice is not given.  Please help us serve you better by keeping your scheduled appointments.

We reserve the right to charge interest on any unpaid balances over 60 days in the amount of 18% as provided by state law.

Service Fee

Any accounts that are not paid by the agreed upon date will incur a $25.00 service fee.

Thank you for understanding our Financial Policy.  Please let us know if you have questions or concerns. 
By signing below, I am indicating that I have read and understand the Financial Policy of Craig Q. Adams, DMD, P.A. and that I agree to abide by these policies as dental services are provided to me and any member of my family.

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