SMILE.

AT RODNEY BRANDT, DDS PS

SMILE.

AT RODNEY BRANDT, DDS PS

Afford Your Care

  1. We appreciate and expect full payment at the time you receive your services.
  2. We recognize you, the patient, as responsible for your charges, even if you have the right to be reimbursed by an insurance company, ex-spouse, attorney, or any other third party.
  3. As a courtesy to you we will bill your dental insurance and are happy to assist you with any details on your insurance plan. However, it is your responsibility to know and keep track of any maximums, deductibles, restrictions, or changes to your insurance plan.
  4. If you have dental insurance that partially covers your charges, we require that you pay your portion at the time of your services.
  5. If your dental insurance does not pay as expected, any remaining balance is your responsibility.
  6. Interest will be charged on balances over 90 days.
  7. We are members of Regence and Washington Dental Service (which includes some Delta plans and the Oregon dental service).
  8. We do not accept new patients with DSHS.

 

See an example of our payment policy form below:

PLEASE INDICATE HOW YOU WILL BE HANDLING YOUR FEES:

  1. Payment in full today by cash, check, credit card, or debit card_____
  2. I have insurance and will pay my portion on the day of treatment____
  3. I have Labor and Industries (L & I) insurance and do not need to pay unless there is a problem with payment on my charges or unless treatment is not covered by L & I_____

Our goal is to provide you with the best possible dental care. If you have any questions regarding our payment policies, please feel free to discuss them with us.

I HAVE READ AND UNDERSTAND THE PAYMENT POLICIES OF THIS OFFICE:

Signature (Patient/Parent):_______________________________________Date:___________

We are happy to estimate fees and insurance reimbursement before beginning your recommended treatments, and we will gladly file insurance forms for you.  Optimal, comprehensive dentistry is what we practice, and we do not base our treatment recommendations on what your insurance will or will not pay.  Our recommendations are based on what is best for you.  Any treatment you choose to receive that is not covered by your insurance is your financial responsibility at the time of treatment unless other arrangements have been made.  If you have any questions, don’t hesitate to ask.  We love finding solutions that allow you to achieve your smile dreams.

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