We, the staff of Aaron Tropmann, DDS. & Gary Oyster, DDS. are committed to providing you with the
highest level of care and to building a successful provider-patient relationship with you and your family.
We believe your understanding of our patient’s financial responsibility is vital to that provider-patient
relationship and our goal is not only to inform you of that financial policy but also to keep the lines of
communication open regarding them. If at any time you have any questions or concerns regarding our
policies, or responsibilities please feel free to contact us.
Please understand that payment for services is an important part of the provider-patient relationship. If
you do not have insurance, proof of insurance, or you participate in a plan that will not honor an
assignment of insurance benefits, payment for services will be due at the time of service unless a payment
arrangement has been approved in advance by our staff.
We make payment as convenient as possible by accepting (cash, personal checks, MasterCard, Visa,
Discover and CareCredit-patient payment plans).
Please remember that your insurance policy is a contract between you and your insurance carrier. We
will, as a courtesy, bill your insurance and help you receive the maximum allowable benefit under your
policy. We have found that patients who are involved with their claims process are more successful at
receiving prompt and accurate payment services from their insurance carrier. We do expect patients to be
interactive and responsible for communicating with your insurance carrier on any open claims.
It is your responsibility to provide all necessary insurance eligibility, identification, authorization and
referral information and to notify our office of any information changes when they occur. Even a
preauthorization of services does not guarantee payment from your insurance carrier. We also require
photo identification when accepting insurance information. It is the patient’s responsibility to know if our
office is participating or non-participating with their insurance plan. Failure to provide all required
information may necessitate patient payment for all charges. When insurance is involved, we are
contractually obligated to collect co-payments, co-insurance, and deductibles, as outlined by your
To best serve all our patients, we kindly ask for 24 hours’ notice if you are unable to keep an
appointment. This allows us to offer the appointment to another patient. If you fail to keep your
appointments without notifying us in advance: a missed appointment fee of $50.00 will be assessed.
I have read and understand the above financial policy. I agree to assign my insurance benefits to Aaron
Tropmann, DDS., PA. whenever applicable. I understand that my dental insurance may pay less than the
actual bill for services. I agree to be responsible for payment of all services rendered on my behalf.
By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.