Office Policy

Revised 1/28/15

Please correct the errors described below.

We feel the best service is based on a frank and friendly understanding between patient and doctor. Accordingly, we have prepared this information sheet to acquaint you with our office policy.


Our fees for treatment are based on our time, skill and judgement in rendering you an excellent result.

It is the policy of this office after examination and diagnosis, to make an estimate of the dentistry to be performed. This will enable you as a patient to know exactly what work is planned and what your financial responsibility will be. Your fee for treatment covers a multitude of services that will be explained to you in detail by the doctor. It is necessary to make definite financial arrangements before any treatment begins. These arrangements will be made with our Business Manager and method of payment cannot be changed unless previously discussed with her. If you should have any questions at any time about your fee, please call our office.

We are pleased that many of our patients have the advantage of dental insurance to supplement the cost of their dentistry. The patient, however, has full responsibility for the payment of the fee according to the established policy of this office. THE PATIENT IS RESPONSIBLE FOR THE PORTION OF THE FEE THE INSURANCE COMPANY DOES NOT PAY AT THE TIME THE SERVICES ARE RENDERED. Financial arrangements must be made before the commencement of treatment and must provide for the completion of payment by the time treatment is completed.

Please realize that we are treating you, not your insurance company. We try to do what is best for you, not what your insurance company will pay for. The fees are an obligation that you have with us. The insurance claim is between YOU and YOUR insurance company. We will be happy to assist you in completing your insurance forms. If desired, our office will also contact your insurance company for a pre-determination of those benefits covered. Please be advised that we are not a PPO or DMO provider. We accept out-of-network insurance, however you may have a higher copay as insurance companies will pay by a set fee schedule that we have no control over. You will be responsible for your portion after insurance is billed.

Payment for services is due at the time services are rendered unless financial arrangements have been made prior to the treatment. Our fees are the same regardless of whether the patient is covered by insurance or not. I further agree to pay all collection costs and fees that require third-party collection or civil action.


The time for your appointment is reserved for you. This is done so that prompt, efficient treatment can be provided for you. If unable to keep your appointment, a 48-hour notice is required so that arrangements can be made for another patient to use this time. Failure to give notice could result in a $50 cancellation fee.

Dental insurance, in fact is not insurance in a true sense. Insurance, such as life, auto, and household is based on the likelihood that death, accident, fire, and theft will not occur. Dental insurance is based on the likelihood that the beneficiary will use dental services. Therefore, the premiums paid for the dental insurance policy determine the amount of the benefits paid. The greater the premium, the greater the benefits, in dollar amounts, and/or in number of dental services provided.

Your employer provides the plan to you as an EMPLOYEE BENEFIT. Your employer determines the amount of premium in dollars he is willing or able to pay. The insurance company tailors a plan for your employer and specifies what services will be covered and what benefits will be paid to fit that premium payment.

When the plan is designed, the insurance company and your employer (sometimes in concert with your union) determine what requirements have to be met for the benefit payout. In some cases, in order for the benefits to be paid, a "pre-treatment" must be filled. The insurance company will then notify you or the treating dentist as to what benefits they will pay. After you have received care, the claim form will be prepared by your dentist and submitted to the insurance company for reimbursement. Benefits usually do not cover the entire cost of treatment. Benefit checks, unless you have made an agreement with your dentist is for assignment of benefits, will be sent directly to you. If the benefit checks are sent to the dentist, you will still be responsible for the difference between the benefits and the total fee.

Employers are jumping to and from insurance companies more and more these days. We encourage you to be familiar with your policy exclusions, deductibles, and required co-payments.

Occasionally, there may be a dispute concerning what you feel is an appropriate benefit payment and what the insurance company is contracted to pay. We will provide the company with sufficient information concerning these services. The insurance company claims agent then makes a judgement in benefits of payment. If this judgement is not satisfactory to you, you have a number of resources open to you. You may issue a complaint through your company's insurance representative (in the personnel or benefits office), through your union, or you may ask us to request a "peer review" through the local dental society. As a last resort, you may issue a complaint to your State Department of Insurance, the agency that regulates the insurance industry.

This information about dental insurance has been provided by this dental office as a service to our patients. Dental insurance is a Fringe Benefit that will help you to pay for the services you receive here. We hope this information will enable you to better understand your dental insurance program.

Dr. Stephen Harris and Staff

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