Bucks County Smiles Financial Policy

Dear Patient:

Please carefully review the following financial policy guidelines.

Bucks County Smiles is a Fee for Service practice, and we require payment for your treatment at the time of your dental visit. We accept cash, personal check, Visa, Mastercard, Discover and American Express.

If your charges are in excess of $400, and you pay in full by check or cash, by the day of your scheduled service, we will extend a 5% bookkeeping courtesy to you. There will be only one courtesy (discount) applied on an account for each service.

If you have a dental benefit plan, we are happy to submit an electronic claim on your behalf. Any dental benefit plan is a contract between you and your dental plan carrier. We cannot guarantee what services will be covered by your plan or what payment amount will be made by your dental benefit plan in contribution to costs of services. Any questions regarding your benefit plan or reimbursement policy should be directed to the benefit carrier or your health benefits coordinator.

Dental benefit carriers will either send payments to you, OR directly to our office.

• If your carrier sends payments to you, full payment for treatment rendered is your responsibility on or before the date of service.
• If your dental plan carrier sends claim payments directly to our office, you may leave a credit card number stored in our secured database. When payment is received from the carrier, the credit card will be charged for any unpaid balance. Your benefit carrier will send you a copy of the explanation of benefits paid or rejected, for your records. Please let us know whether you wish to receive a receipt for the credit charges. If your dental treatment fees exceed the benefit plan maximum amount of benefit available, you will be asked to pay the overage amount on or before the date of service.

After 60 days, if we do not receive payment from your insurance plan, the balance will become the responsibility of the patient. Unpaid patient balances will be forwarded to collections after 90 days of non-payment.

Any appointment that is broken or cancelled with less than 24 hours’ notice will be assessed a fee of $50 per half hour of appointment time. We will charge a fee of $25 for returned checks.

Thank you for your cooperation regarding our Financial Policy. We promise to provide oral healthcare of the highest standards to you, our valued patient.