1720 LorRay Drive . North Mankato . 507.345-7786 . lddental@hickorytech.net  
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   Excellence by Choice
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 Excellence by Choice

 
 
Office Financial Policy

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Thank you for choosing our office for your dental needs. We  realize that every person´s financial situation is different. For this reason, we have worked hard to provide a variety of payment options to help you receive the dental care you need and deserve. The payment options will allow you to enjoy a healthy, beautiful smile with respect to your budget. We are always available to answer your questions or assist you in any way we can.
To maintain the practice operations and prevent potential misunderstandings, we ask patients to accept and adhere to the following financial arrangements regarding their dental treatment.

 


If you are a member of a Dental Insurance Plan and have chosen us as a provider of your care, it is your responsibility to:


- Pay your deductible or co-pay at the time of service. 

- Pay for services not covered by your insurance carrier.                                    

- Provide us with information relative to your claim, including insurance card number, employer, birth date, address and Social Security number. This information is requested on the Health History Form, which we ask that you complete during your initial or subsequent visit.

“As a courtesy, insurance claims for your carriers are filed at no charge to you.”


                                OPTIONAL PAYMENT TERMS:


FULL PAY CASH DISCOUNT: We offer a 3% accounting courtesy for all treatment for which your co-pay is paid in full (cash or check) at the time of service.
MAJOR SERVICE:  Two Payment Option: We offer a two-payment option for Crown, Bridge and Denture treatment. We ask that you pay one-half of your co-payment at the first appointment and the second half at the seat date appointment. A 3% accounting courtesy is given on the co-payment portion when paid with cash or check.
TERM LOAN: By arrangement with Wells Fargo, we offer our patients, upon approval, an interest-free term loan (up to 6 months) with no down payment, no annual fee, and no prepayment penalty. Please ask for an application.
Estimated patient balances are collected the day services are provided. Please be aware that estimates are based on limited information provided by your dental plan and are no guarantee of payment. Please contact your dental plan directly if you have any questions concerning dental coverage. For your convenience, we accept Visa, MasterCard, or Discover. Extended payment plans are available (no interest for 90 days through Wells Fargo with application approval)´


CANCELLATION POLICY


- We require a 48-hour cancellation notice for a scheduled appointment.
- Patients who fail to show for their scheduled appointment without giving due notice, may be charged a $75.00 fee. This is not payable by your insurance.