Insurance
Do you accept my insurance?
We currently work with 100+ dental insurances, this includes ALL PPOs, most Medicare Advantage, Some HMOs as well as Some Medicaid. As a courtesy to our patients, We assist you to file all dental claims. Following list isn’t meant to be a comprehensive list, so please call our office should you have any question or concern about specific insurance plan, as one of our trained insurance coordinators would be more than glad to verify your dental insurance benefits prior to your actual dental visit and also get back to you with a prompt response within 30-60 minutes 9 out of 10 times :).
- Aetna
- Aflac
- Ameritas
- Anthem
- BCBS (including Federal plans)
- Careington
- Cigna
- Delta Dental
- Dental Network of America (DNOA)
- Dentaquest
- Guardian
- GEHA (Connection)
- Humana (including Humana HMO gold)
- MetLife
- Principal
- Sunlife
- United Health Care (UHC)
- United Concordia (UCCI)
- and many more …
CareCredit:
- If you’re interested in an easy way to manage dental costs, we recommend that you consider interest-free CareCredit. CareCredit works like a credit card for healthcare, but as long as you pay off the balance in the agreed period, you will not be charged any interest!
- You choose the payback period based on monthly payments that you know you can fit into your budget. In addition to dental treatments, CareCredit can also be used for vision care and other health, beauty, and wellness needs.
- Please let us know if you would be interested in learning more about CareCredit, and a member of our team will help you apply. Or you can apply online at CareCredit.com.
In-House Payment Plan: We offer flexible payment options to our patients. Please call us for more detail.
Other Payment Options: At Divine Dental, we are pleased to accept the following payment methods.
- Cash
- Debit
- American Express
- CareCredit
- Discover
- MasterCard
- Visa
- Flexible Spending Accounts (FSA)
- Health Savings Accounts (HSA)
Also, ask us about our payment plans that divides your dental fees into installments.
OUR FINANCIAL POLICY:
Thank you for choosing our office as your dental healthcare provider. It is our mission to create a practice that provides our patients with the highest level of care and concentrates on delivering comprehensive and ethical care. The following is a statement of our financial policy which we require that you read and sign prior to any treatment.
PAYMENT
We offer several payment options for your convenience. Please note there is a $25 fee for returned checks
INSURANCE
Your insurance policy is a contract between you and your insurance company and we are not a party to that contract. Our relationship is with you, the patient, and as a courtesy to you, we will help process your dental insurance claims. We will attempt to verify eligibility and benefits prior to your appointment and will gladly provide you an insurance estimate prior to treatment. Please note the following :
- An insurance estimate is not a guarantee of eligibility, benefits or payment. The final amount paid will ultimately be determined by your insurance company.
- Some or all of the services provided may or may not be covered by your insurance policy
- Copayments, deductibles, and any service/amount not estimated to be covered by your insurance is due in FULL at the time of services are rendered, unless otherwise discussed.
- Insurance payments are usually received 30-60 days after filing a claim. Any claims not paid within 60 days automatically become the responsibility of the patient. It is the patient’s responsibility to contact their insurance company and inquire what benefits they are eligible for and if payment is expected.
- We ask that you sign this form and/or any other necessary documents that may be required by your insurance company. This form instructs your insurance company to make payment directly to our office. I authorize the release of any information concerning my (or my child’s) health care advice and treatment provided for the purpose of evaluating and administering claims for insurance benefits.
- We will cooperate fully with the regulations and requests of your insurance company that may assist in the claim being paid. Our office will not, however, enter into a dispute with your insurance company over any claim.
MINORS
The parent or legal guardian accompanying a minor who has consented to treatment, are responsible for full payment at time of service. Unaccompanied Minors: The parent or legal guardian is responsible for full payment at time of service. Treatment consents and payment arrangements with the parent or legal guardian must be made prior to appointment or non-emergency treatment will be denied.
DELINQUENT ACCOUNTS
Please note that any account with an unpaid balance over 30 days is subject to a $25 late fee every month until the balance is addressed. After 90 days, the account will be sent to collections.
FINANCIAL CONSENT
The patient (account holder) agrees to be fully responsible for total payment of treatment performed in this office.
“I understand and agree to this Financial Policy and Agreement. Furthermore, I authorize release of any information relating to this claim or any insurance information. I authorize my insurance company to pay my dental benefits directly to my dental office. I understand that responsibility for payment for dental services provided in this office for myself or my dependents is mine, due and payable at the time services are rendered. I understand that I am responsible for all dental treatment not covered by my insurance.”
MISSED APPOINTMENT(S) & CANCELLATIONS
Our goal is to provide the best dental services to our patients and to ensure we are doing that we require a 48-hour cancellation or rescheduling notice. We understand that unforeseen circumstances may arise, which may result in canceling or missing your appointment. As a general rule, there is a cancellation/no-show fee of $50 per hour. If a patient is more than 15 minutes late for their appointment that is considered a no-show and a $50 per hour fee will be assessed unless otherwise discussed with the office staff. All appointments will require a deposit to be booked. The deposit will be applied to the appointment for the day and if patient does not utilize the full amount of the deposit, the remaining credit will be refunded to the patient. If the patient cancels without a 48 hour notice or does not attend their appointment, the deposit will then be forfeited and used towards the cancellation fee. A charge will be assessed for multiple missed, short notice, or canceled appointments. Multiple failed appointments may result in being dismissed as a patient from the office.
CREDIT CARD AUTHORIZATION
It is our office financial policy to obtain your credit card number and authorization to process payment for charges not covered by your insurance carrier and for all cosmetic and aesthetic procedures. In providing your credit card information, you authorize payment by credit card for services in the absence of coverage by your plan including but not limited to co-payments, deductibles, co-insurance, missed appointment and all uncovered services rendered by Divine Dental and received by you. This credit card authorization form will allow us to process any no-show/cancellation fees, appointment deposits, and outstanding account balances after insurance payments. To ensure complete confidentiality, your credit card will be stored directly in your patient record, in a HIPAA and PCI compliant software. To obtain this credit card information, we will call you on the phone number provided and enter the information directly in to the software to ensure it is not written down. You (I) authorize Divine Dental to charge your (my) credit card for agreed upon cancellation fees, deposits and outstanding balances. You (I) understand that your (my) information will be saved to file for future transactions on your (my) account.
