Thank you for choosing Gentile Dental Care as your dental provider. We are committed to providing you with the finest care available. Therefore it is very important that we understand and agree upon the financial obligations which will be incurred as a result of the services rendered. Please read the following policy and sign below.
IF YOU HAVE INSURANCE COVERAGE
PROOF OF INSURANCE: It is your responsibility to provide current valid proof of insurance. If you fail to provide us with the correct information or do not have an up-to-date insurance card, we cannot properly file your claim and you will be responsible for all charges incurred. Please contact your insurance company if you are unsure of your coverage
COVERAGE: If your insurance changes, please notify us before your next visit to avoid unexpected charges.
CLAIMS SUBMISSION: As a courtesy, Gentile Dental Care will file a claim with your insurance company for any services provided and assist you in any way we can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim.
CO-PAYMENTS AND DEDUCTIBLES: All non-covered portions, co-payments and deductibles are due upon delivery of products or services and must be paid at the time of service unless an alternative payment method has been agreed upon in writing.
DEPOSITS/DOWN PAYMENTS: Prior to beginning any work, we will estimate the co-payments. Deductibles may incur based on the information we obtain from you and your insurance company.
NON-COVERED SERVICES: Please be aware that some services and/or products may not be covered by your insurer. You must pay these services in full at the time of the visit unless other financial arrangements have been made in advance.
