Financial

Your First Visit | Regular Checkups | Financial | Patient Forms

Our office is committed to your child’s dental treatment. Please understand that payment of your bill is considered part of treatment. We make every effort to keep down the cost of your child’s dental care. You can help by following our office guidelines. We ask that you read and sign this agreement prior to treatment.

We accept cash, checks, Visa, MasterCard, American Express and Discover.
Full payment is due at time of service.
Insurance deductibles and co-payments are due in full at time of service.
Payment arrangements may be offered prior to treatment.

Because of the difficulty of third-party billing, in the event of divorce or separation, the parent who signs our financial policy for the child will be financially responsible for treatment costs.

As a courtesy to our patients, we accept assignment on most dental insurance. We would need all of your insurance information prior to the visit. We will verify coverage and inform you of the estimated balance due. In the event we cannot get this detailed information, we would require payment in full and a statement of actual services will be provided to you so that you can be directly reimbursed by your insurance carrier. If your carrier has not made payment in 60 days, your outstanding insurance balance will be your responsibility. Due to the many different insurance policies and frequent changes in coverage, it is impossible for us to know them all. Please familiarize yourself with your dental coverage. We recommend that you contact your insurance carrier to understand your benefits. Please know your insurance policy is a contract between you and the carrier. We are not a party to that contract, therefore it is important for you to be involved to help assure timely payments on your account.

Our practice is committed to providing the best dental care for your child. We charge what is usual and customary for our area. You are responsible for payments regardless of any insurance company’s arbitrary determination of usual and customary rates.

Our practice is “amalgam free.” We use composite (white) restorations. Our office is committed to providing our patients with the best dental care possible. In keeping with that commitment, we feel that a composite restoration is the best filling material for children and young adults. Our office recommends treatment based on what we feel is in the best interest of your child’s dental care, NOT what your insurance carrier will pay for.

Charges will not be made for broken appointments and cancelled appointments with a 24-hour notice. We do reserve the right to terminate our professional relationship if you fail to keep three appointments. Please help us serve you better by keeping your scheduled appointments.

Any expense incurred for returned checks, legal fees and collection agency fees will become your responsibility and will be added to your account balance.

We know questions can arise on billing matters. We encourage you to discuss any financial concerns that you may have so that we may assist you in the effective management of your account.

Dr. Mickey and Associates

Financial