BILLING PAYMENT POLICY

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.

IF YOU DO NOT HAVE INSURANCE COVERAGE

If you do not have insurance coverage, payment in full is due on the date of services. We offer
several financing options, such as Care-Credit and Capital One. We will gladly help you with the
application process for any of these healthcare credit plans.

NON-PAYMENT/DELINQUENT ACCOUNT

Please be aware that if a balance remains unpaid, or if your account is 90 days past due, we may refer your account to a collection agency.

THERE IS A CANCELLATION FEE OF $75 FOR ALL PATIENTS THAT NO SHOW OR CANCEL A
SCHEDULED APPOINTMENT WITHIN 24 HOURS OF THE APPOINTMENT TIME. DOWN CODING IS PATIENT RESPONSIBILITY.

It is not our intention to place our patients in a position of hardship or financial burden. However, it is important to resolve outstanding balances in a mutually agreeable fashion so that we can continue to provide our patients with high quality care. It is for this reason that no exceptions will be made to this policy without a written agreement. If you need financial consideration, it is your responsibility to request it prior to the provision of products or services. Thank you for your understanding and cooperation in this matter. We accept cash, and all major credit cards for payment.