Dear Patient(s):

This letter is to inform you of our office policy regarding dental insurance. As a courtesy to our patients, we will accept assignment of most insurance companies, providing your carrier will issue payment directly to our office. This policy does not apply to out of province residents or policies that issue payment directly to you. Please note that you are responsible for submitting to any health spending accounts. We will take care of processing your insurance claims. We accept assignment of benefits provided you leave a credit card number on file with us. Any patient portions are to be paid at the time of your visit or if a balance is unavailable at your appointment we ask that your account be cleared immediately upon receiving our statement. Appointments will only be scheduled if your account is current.

We ask that you, in turn, are aware of your coverage and insurance limits and that you make this a priority. If possible, please provide us with a copy of your insurance handbook dental section. Your insurance is a contract between you and your insurance company; the dental office is regarded by your insurance company as a third party. Anything not covered by your insurance or that exceeds your insurance limit is your responsibility. Policyholders with plans that are 100% are not necessarily insured for 100% of all procedures and in such a case will be issued a statement when our office has received word from the insurance company. OUTSTANDING BALANCES ARE TO BE CLEARED AT THE TIME OF YOUR APPOINTMENT.

Should your dental claim need to be resubmitted for payment, we ask that you assist us in every way possible to ensure your insurance company receives the claim. In the case where we have submitted a claim with no resulting payment, please be advised that this balance will then become your responsibility.

We are here to assist you with any questions you may have concerning your coverage.

IF YOU ARE UNABLE TO KEEP YOUR RESERVED APPOINTMENT TIME, WE REQUIRE A MINIMUM OF 2 BUSINESS DAYS NOTICE TO ALLOW US TO SCHEDULE A PATIENT FROM OUR WAITTING LIST. FAILURE TO PROVIDE THIS NOTICE WILL RESULT IN A RESCHEDULING FEE.

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