Our office will accept an assignment of benefits from your insurance company with the provisions listed below. It is important to understand though, that the agreement regarding your dental benefits is between you, your employer, and your insurance company. The obligations you have with our practice is to pay for treatment, regardless of the amount that may not be reimbursed by your insurance company. The following provisions identity our policies governing insurance claims:
- Although we are willing to complete insurance information informs and submit a claim on your behalf, we do not accept responsibility for the outcome of the transaction. Completing insurance forms is a courtesy we extend to you in an effort to save you time and to facilitate payment to our office from your insurance company. By having our office process your insurance forms, it is important that you understand that this does not eliminate your financial obligation for your treatment.
- We require you to sign our agreement and/or any other necessary assignment documents that may be required by your insurance company. This instructs your insurance company to make payment directly to our office.
- We require you to pay the estimated co-payment, which is the amount not covered by your insurance company, at the time we provide service to you. The co-payment is only an estimate o charges and may be found to be insufficient after review by your insurance company.
- Insurance payments ordinarily are received within 30-60 days from the time of billing. If your insurance company has not made payments to our office within 60 days, we will ask you to pay the entire balance at that time. you will be responsible for seeking reimbursement from your insurance company at this time.
- Our office does not guarantee that your insurance company will pay for treatment you receive from our practice. We perform routine insurance billing procedures upon verification fob coverage. However, if your claim is denied, you will be responsible for paying the full amount at that time.
- Our office will not enter into a dispute with your insurance company over any claim, although we will provide necessary documentation your insurance company requests to sort out any confusion or questions that may arise. We will cooperate fully with the regulations and requests of your insurance company. It is ultimately your responsibility to resolve any type of dispute over payments made or not made by your insurance company.
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990 Highway 287 North, Suite 112
Mansfield, TX 76063
Monday - 8:00 A.M. - 4:00 P.M.
Tuesday - 9:00 A.M. - 6:00 P.M.
Wednesday - Closed
Thursday - 9:00 A.M. - 6:00 P.M.
Friday - 8:00 A.M. - 4:00 P.M.
Saturday - 8 A.M. - 12 P.M. (2 per month)