Payment is expected at the time of service unless other arrangements have been made in advance. If you have private indemnity insurance, we will bill your insurance carrier for you at no charge, provided you have assigned the benefits for the treatment rendered to the office. We will bill up to two insurance earners for any given treatment series at no charge. If there is a need to submit additional forms, there will be a charge of $10 for each additional form billed. If there is an overpayment by your insurance company for any treatment sequence, we will refund the overpayment to you or your insurance company on a regular basis. If it is ascertained that your insurance company has made a payment in error, it will be the responsibility of the insured to provide reimbursement to the insurance carrier.

We expect timely payment for services rendered from your insurance carrier. If there are any delays in payment, we will send you a statement requesting payment in full after 30 days. We will begin to assess finance charges (.833% month / 10% APR) on the unpaid balance 60 days after treatment has been rendered. We encourage you to contact your insurance carrier regarding payment to avoid any additional finance charges. We accept Visa, MasterCard and Discover, and have other financing plans available.

In the event that it is necessary to initiate collection proceedings on your account, you will be responsible for all attorneys’ fees and cost of collection.

THERE IS A $50 (minimum) CHARGE FOR CHECKS RETURNED FOR ANY REASON.