Financial Policy Statement

Please correct the errors described below.

Payment for all services is expected on the date of service, including deductibles and copays. For services which require multiple visits, payments may be made in installments and paid in full on the date of completion

Highland Dental Associates, P.C. will submit claims for services to your (non HMO) dental plan when complete and accurate insurance information is provided to our office prior to your appointment. We will allow 60 days for a response from your plan.

It is your responsibility to understand your dental plan’s covered services, restrictions, and limitations. Services not covered by your plan are your financial responsibility.

If you have a balance due after we have received payment/response from your dental plan we will mail you one request for payment via a paper statement. Full payment is expected upon receipt and may be made in person, by mail or online.

Fees: Multiple Payment Request Fee - $5 for each paper statement sent after initial request for payment

Insufficient Funds: $15 each returned check

Delinquent Account: 2%/month on outstanding balance – interest added if account is 90 days overdue

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