the initial examination we will provide you with an estimate of your insurance
your convenience, we will gladly assist you in submitting insurance claims
relating to charges for care rendered in our office.
Please be advised, however, that our primary financial relationship is
with our patients or their families and not with their respective insurance
responsibility for collection of insurance benefits rests with the insured
professional services are rendered and charged directly to the patient or
their family, and they are responsible for payment of all fee incurred
Accepts Assignment of Benefits
Professional Fee=Patient Account
Estimated Ins. Benefit paid directly to office
Patient Account Balance paid based on financial agreement
patient is encouraged to know what the benefits are before treatment starts.
If you are not sure, contact your insurance company so that you will know
exactly how much you can expect to be paid and when to expect payment.
We would be glad to assist you in obtaining this information.
We ask that you provide us with the name, address and telephone number of
your insurance carrier as well as a copy of your card with all the appropriate
cannot render services on the assumption that our charges will be paid by an
You may, however, endorse your insurance payments to our office.
We will be happy to credit these to your “insurance” account.
If your company notifies you that it requires verification of continuing
treatment, please let us know and we will make appropriate arrangements to
forward that information to your insurer.
If your insurance carrier provides a form for verification of continuing
treatment we will be glad to complete it.
If they do not, we will generate one as necessary.
If in the event you or your employer terminates the insurance
during the course of treatment, you will be responsible for all remaining unpaid
do not hesitate to discuss any questions you have in regards to this.