Financial & Insurance Information
Thank you for selecting our office for your periodontal care. We are committed to providing the highest level of quality, preventative treatment.
Please understand that payment for services rendered is part of your treatment. Outlined below is our financial policy. Please read it carefully, print out the .PDF (Printable Document Format) form at home and sign it below indicating you understand our policy. You may mail the form to 2901 Wilshire Blvd., Suite 405, Santa Monica, CA 90403 in advance of your appointment, or bring it with you that day.
Financial Policy
- Full payment is due at the time of service.
- We accept cash, checks, Visa, Mastercard and American Express.
- If you have dental insurance, and you have obtained a pre-estimate, you are expected to pay your estimated portion, and/or deductibles at the time of service.
- You may elect to pay the entire case fee for all recommended treatment in advance and receive an 8% bookkeeping discount. (Cash or check only). In the event of overpayment a refund will be issued upon completion of treatment. (This option is not applicable for dental implants).
In the best interest of your dental health, your treatment plan will be based on the diagnosis made by your doctor, and you will be informed of the estimated cost of your treatment.
If you have dental insurance, your treatment will not be dictated by available benefits. We will gladly assist you in collecting insurance reimbursement, providing you supply us with a fully completed dental claim form. Upon request, we can obtain a pre-determination of dental benefits prior to treatment. Be aware, however, that a pre-determination is not a guarantee of payment, and that you are directly responsible for the payment of all fees. If your insurance company has not paid your claim within ninety days you will be expected to pay the total balance owed.
Any balance over 90 days will be charged an annual finance fee of 18%. To avoid finance or rebilling charges, we ask that you comply with our financial policy.