Patient Information

Thank you for choosing us as your provider for dental services. We are committed to your treatment being successful. Please understand that payment of your bill is considered a part of your dental treatment.

DENTAL INSURANCE

The patient in the dental chair

As a courtesy to our patients we accept all dental insurance. Although we do NOT participate in any network, we still file and accept all insurances. *Attention all Delta Dental Policy Holders and Blue Cross Blue Shield Federal Holders* Dr. Adams and Dr. Cheek are NOT participating providers with Delta Dental and Blue Cross Blue Shield Federal, because they send payment directly to the patient. Therefore, we ask all patients covered by Delta Dental, Blue Cross Blue Shield and Blue Cross Blue Shield Federal to pay in full on each visit. PAYMENT PLANS Dr. Adams and Dr. Cheek offer outside financing through Care Credit. Care Credit has same-as-cash programs with financing terms of 6, 12 or 18 months interest and finance free upon credit approval.

METHODS OF PAYMENT

We accept MasterCard, Visa, Debit Cards, Money Order, Certified Check, Discover, American Express, Cash and Care Credit.

FINANCIAL POLICIES

The following is a statement of the financial policies of Adams and Cheek Dentistry, which we require you to read and sign prior to any initiating treatment. All patients must complete our information and insurance form before seeing the doctor.

FULL PAYMENT IS DUE AT TIME OF SERVICE. WE ACCEPT CASH, PERSONAL CHECKS, DISCOVER,  MASTERCARD/VISA, AMERICAN EXPRESS AND CARE CREDIT.

Regarding Dental Insurance
In most cases we will accept assignment of your dental insurance benefits. However, we do require your portion of the bill (also known as copayments) to be paid at time of service. The balance is your responsibility whether your insurance company pays or not. We cannot bill your insurance company unless you give us your insurance information and a copy of your insurance card. Your insurance policy is a contract between you and your insurance company. We are not a party to that contract. Please be aware that some, and perhaps all, of the services provided may be non-covered services and not considered reasonable and/or necessary under your insurance.

Usual and Customary Rates
Our practice is committed to providing the best treatment for our patients, and we charge what we feel is a fair fee for the services rendered. You are responsible for payments regardless of any insurance company’s arbitrary determination of usual and customary rates.

Minor Patients
The adult, parent or guardian accompanying a minor is responsible for full payment of services unless prior arrangements have been made. For unaccompanied minors, non-emergency treatment will be denied unless charges have been pre-authorized to an approved credit plan, Visa, MasterCard or payment by cash or check at time of service has been verified.

Missed Appointments
We understand that schedules sometimes change with short notice, but we would like the courtesy of 48 hours notice if you need to cancel an appointment. We reserve the right to charge $50.00 to $l00.00 per hour for missed/broken appointments when 48 hours notice is not given. Please help us serve you better by keeping your scheduled appointments.

Interest
We reserve the right to charge interest on any unpaid balances over 60 days in the amount of 18% as provided by state law.

Service Fee
Any accounts that are not paid by the agreed upon date will incur a $50.00 service fee.

 

Policies

Financial Policy

Missed Appointment Policy

Privacy Policy

Authorization for Use and Disclosure of Info

Authorization to Release Health Information

Authorization to Release Health Information to Adams & Cheek

Acknowledgement of Receipt of Notice of Privacy Practices