We are committed to providing you with the best possible dental care.
Our professional services are rendered to you, not your insurance company.
Our fees reflect our professional commitment to excellence and generally,
but not necessarily, fall within the Usual and Customary fee structure
determined by your carrier. We do not allow insurance companies to dictate
treatment according to their guidelines. Unlike insurance companies, our
practice and its providers keep our patient’s best interest in mind.
For patients with no dental insurance, payment is due in full at each appointment
as services are rendered. Patients with dental insurance coverage are required
to pay the Usual & Customary Percentage that your dental insurance
company will not pay at each appointment as services are rendered. A 50%
deposit is required for lab involved procedures at the first visit.
Co-payments collected may not include your individual deductible or non-covered
fees. If the percentage collected differs from your dental insurance plan
coverage you will be billed for the balance. Your signature below authorizes
your insurance company to pay Dr. Janis Moriarty directly for services
rendered on all insurance submissions and allows the dentist to release
all information necessary to secure the payment of benefits and to balance
bill you if allowed by contracted and or non-contracted insurance plans.
We are not responsible for procedures not covered by your insurance plan.
You can speak to any of our administrative staff to make financial arrangements
that are reasonable for both parties involved only if your co-pay or balance
is substantial. Ask about our P.A.C.T. Program. P.A.C.T. cannot be used
for Invisalign cases. Our Invisalign fee(s) must be paid in full when the
case is accepted. If you feel the financial arrangement is not feasible
and you wish to proceed with your treatment, we ask that you pay in full
with your Visa, MasterCard or Discover. Balances on account must be paid
in full before other treatment can be started. The dental/medical field
deals with considerable increases as a cost of doing business and to remain
compliant. Our fees may be adjusted without notice but treatment planned
fees will be honored for 3 months. We require that any products purchased
be paid in full at the time of your visit.
We can provide you with a treatment plan that will show you our fees and
what you are ultimately responsible for without insurance coverage. It
will display what insurance is "expected" to pay but since it
does not know the specifics of your dental plan we will do our best to
send a pre-estimate for your convenience. A pre-estimate is a request for
a benefit breakdown from your dental plan. This will give our office and
you a better idea of your approximate co-payment for your dental procedures.
This is typically done for Type II - Restorative & Type III - Major
(Crowns, implants, bridge, partials, etc) procedures. Your co-payment is
expected at the time services are rendered.
Your dental benefit program is a contract between you, your employer,
and the insurance company. As a courtesy to you we will submit your dental
claim(s) to your dental insurance plan. You are responsible for understanding
the coverage, guidelines and limitations of your dental insurance policy.
Our office will not be responsible for any non-covered services under any
circumstances. You are responsible for any unpaid portion from a dental
claim on yourself or family member(s) under your account including but
not limited to deductibles, reaching or exceeding your maximum, frequency
limitations, age limitation clause, missing tooth clause, multi-surface
allowance clause, waiting period, alternate code clause, non-coverage of
resin (white filling material) restorations. You are responsible for providing
us with sufficient dental insurance information to submit your claims.
We require your social security number if your dental insurance uses it
as your subscriber I.D. to properly submit your claims and pre-estimates.
If you do not wish to give us your social security number to properly submit
to insurance you will be responsible for paying for services rendered in
full at each visit. We can supply you with a dental claim form for you
to submit to your insurance company for reimbursement.