Financial Information Financial Policy Dental Benefits  » We are pleased that many of you have dental benefits and our office will assist you in obtaining the  » maximum benefits specified in your contract. However, your benefits are a contract between you,  » your employer, and a carrier. We will assist you in determining your benefits as best we can.  » Because plans differ from carrier to carrier and policy to policy, our office may refer you to your  » carrier or your employer’s benefits coordinator for assistance in understanding your plan.  » As a courtesy to you, we will file your benefits claim and accept assignment of benefits. We ask  » that your estimated co-payments and deductible be paid at the time of service.  » Balances with benefit claims outstanding more than 90 days may be reverted back to the patient.  » Not all services are a covered benefit in all contracts. Some carriers and employers select only  » some services to be covered. You are responsible for payment of all services regardless of the  » payable benefit. Patient Portion Any estimated amounts due and payable by the patient (including co-pays and deductibles) are required to be paid on or by the day the services are performed Methods of Payment 1. Dental Benefits (Please review: Dental Benefits are Estimated and Composite versus Silver Filling Benefits) 2. Cash, Check, MasterCard, and Visa 3. Dental Fee Plan by Capital One (3rd party financing) 4. Citi Healthcard by CitiGroup (3rd party financing) Aged Accounts  » Balances older than 60 days may be subject to additional fees and interest of 1% per month, or 12%  » annually. These additional fees will be applied to the unpaid balance at the end of the second month.  » In the event that your account is not paid and we refer the account to collection, you will be  » responsible for all fees incurred for collection of your bill (i.e., attorney fees, court costs and  » collection agency fees). Appointment Policy We respect your time and ask that you respect ours by honoring your appointment commitment. A. broken appointment is a loss to everyone. Remember, once you have made an appointment, this time is reserved for you. Please give us at least 48 hours notice if you are unable to keep your appointment. This will allow us to accommodate the needs of other patients more readily. If we do not receive a cancellation notice within 48 hours, a cancellation fee may be applied to your account. Dental Benefits are Estimated Abella Dental is committed to optimal care: which means that we will not do anything for you that is less than what we would want for our families or ourselves. We will always recommend the procedure that is the best clinical option for a given diagnosis. In the past few years, there have been major changes in the healthcare industry. We are sure you are well aware of the drastic impact the health care crisis and insurance costs have had on medical care across the nation. We are very concerned that rising insurance premiums and contractual exclusions are now threatening the quality of dental care and the relationships we enjoy with our patients. Many carriers now commonly pay an “alternate benefit” or “least costly equivalent benefit” when multiple methods of treatment are available. We do not believe our patients want us to compromise our integrity by offering a lower quality of dental care, and we believe our patients value their natural teeth enough to pay a portion of the cost to keep them healthy. Please be assured that our team has spent many hours discussing these issues and that we have our patients’ best interest in mind. We will make every effort to verify with your carrier your plan parameters. In most cases though, this information is simply not made available to us until your claim is adjudicated (paid) by your carrier. It is our intention to provide you with most accurate cost estimate for your total out-of-pocket cost and eliminate any billing “surprises”. We will collect from you at the time of service the amount we believe to be correct based on the information we have been provided by you or your carrier. If after final adjudication of the claim an “alternate benefit” or “least costly equivalent benefit” is paid then the difference in the cost will be the patient’s responsibility. At that time an invoice will be mailed to you. Abella Dental is proud to offer our patients the best dental care available and the best options for restoring teeth to their optimal function. We will not let the insurance industry’s standard of least costly equivalent care dictate our treatment plan or your care. Top Composite versus Silver Filling Benefits Again, Abella Dental is committed to optimal care: which means that we will not do anything for you that is less than what we would want for our families or ourselves. For this reason we do not offer amalgam/silver/mercury fillings as an option in your dental care. However, amalgam is still the preferred filling of choice in the back of the mouth by most insurance companies, and commonly paid as an “alternate benefit” or “least costly equivalent benefit” when other materials are used instead of amalgam. We will make every effort to verify with your carrier whether or not composite (resin) fillings are a part of your plan parameters. In most cases though, this information is not made available to us until your claim is adjudicated (paid) by your carrier. It is our intention to provide you with most accurate cost estimate for your total out-of-pocket cost and eliminate any billing “surprises”. We will collect from you at the time of service the amount we believe to be correct based on the information we have been provided by you or your carrier. If after final adjudication of the claim an “alternate benefit” or “least costly equivalent benefit” is paid then the difference in the cost will be the patient’s responsibility. At that time an invoice will be mailed to you. Abella Dental is proud to not offer amalgams as an option and to not let the insurance industry’s standard of least costly equivalent care dictate the use of amalgam in your mouth. A Note to Delta Dental Patients: On the majority of plans Delta Dental only allows for reimbursement of amalgam (mercury) fillings in the back of the mouth. As noted, Abella Dental does not place amalgam (mercury) fillings. Your benefit will be based on an amalgam filling and not a composite (resin) filling. The difference in cost, per your contract with Delta Dental, is yours Top