Financial Arrangements, Insurance Authorization and Billing Information | The Denture Specialist

Financial Arrangements

It is our desire to hold our cost to you, our patient, as low as possible. ln order to do this, we must have a constant cash flow in our business. For your convenience, we accept cash, checks and major credit cards. For major services, including fabrication of dentures and partial dentures, our office requires payment of ONE-HALF down at the time the impressions are taken and the balance to be paid prior to delivery of the dentures. All other services require payment at the time services are rendered. lf this presents a problem to you, please let us know and we will be happy to reschedule you for a more convenient time.
Insurance Authorization & Billing Information

We bill insurance as a courtesy to our patients. Patients who carry dental insurance understand that all services will be charged directly to the patient prior to the completion of treatment. lnsurance is billed as a reimbursement to the patient at the end of the treatment period. lt is understood that the patient/responsible party agrees to be fully responsible for the payment of services. Please note, all claims are submitted with no guarantee of payment. I have read and accept the terms and conditions outlined above by The Denture Specialist as it relates to payment for services. I agree to be fully responsible for the payment of services provided to me by The Denture Specialist office. lf applicable, I give The Denture Specialist permission to submit dental claims for services on my behalf. To the extent permitted by law, I consent to your use and disclosure of my protected health information to carry out payment activities in connection with any claims.
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Financial Arrangements

Insurance Authorization & Billing Information