SWANSON DENTISTRY PAYMENT INFORMATION
We at Swanson Dentistry understand that dentistry is often an investment. We ask that you please pay your estimated portion due at the time your service is rendered. We always attempt to advise you of this estimated amount prior to treatment, but if we fail to, please ask us for that estimate. It is important that we verify your dental insurance coverage and benefits, so please give us that information prior to your appointment If we are unable to verify them, we must ask that you to pay the full amount due at the appointment and then refund you if insurance does pay.
Insurance and the human body are often unpredictable, so the quotes we give you are estimated amounts and can change; therefore, it is occasionally necessary to adjust your payment due after insurance benefits are received.
PATIENT PAYMENT RESPONSIBILITY
I understand it is my responsibility, and not the office’s responsibility, to know the terms and limits of my own insurance coverage. I understand that all insurance payments quoted by the practice are only estimates and cannot be guaranteed. I understand that I am responsible for all charges, regardless of the actual insurance payment.
Overdue balances may be subject to an interest charge of 1.5% per month (18% per year) or submission to a national collection agency. If outside collections are necessary, I understand that I am responsible for all collection expenses, additional handling fees, and any court fees.
I authorize insurance payments be made directly to the dentist. I also approve the release of any medical care information requested by my insurance carrier.