ROSS S. HEADLEY, DDS
Please read our financial policy, sign, and date it. We will scan the document into our computer system and give you the original for your records. The purpose is to prevent any misunderstandings regarding financial responsibility for services rendered. Thank you!
We will file all dental insurance claims. Patients are responsible for giving us current insurance cards and pertinent information at the time of treatment. Otherwise the patient will be asked to pay in full for services at the time of that visit. Upon request, a predetermination of benefits will be filed. Please do not request a predetermination if you are not ready to schedule your procedure within six to eight weeks. Most predeterminations expire after 90 days.
All co-pays (out-of-pocket) and scheduled payments are collected upon arrival. The patient is responsible for the remaining balance after insurance pays. Some insurance companies pay the patient, not the doctor. In that case, payment is due in full before treatment is rendered. Financing is available through Care Credit for patients who qualify.
If the patient is a minor with divorced parents, the parent that schedules the child for treatment is responsible for payment. The doctor is not part of any divorce decree.
If you have minors coming to their visits on ther own, they will be expected to have their co-pay at the time of their visit. To make this easier you may call ahead with a credit card number.
Please be aware that some procedures are not covered by insurance. We do not file cosmetic and non payable procedures such as tooth whitening and purely appearance enhancement porcelain treatments. You will be told in advance if this applies to your treatment.
If you do not agree with the policies, please ask to discuss this with the appropriate person.