Please familiarize yourself with the following information. If you have any questions, please feel free to ask one of our business office staff.
Please be aware that the parent bringing the child to our office is legally responsible for payment of all charges. We cannot send statements to other persons.
Payment for professional services is due at the time dental treatment is provided. Every effort will be made to provide a treatment plan which fits your timetable and budget, and gives your child the best possible care. We
accept cash, personal checks, debit cards and most major credit cards.
For the convenience of our patients with dental insurance, your estimated patient portion will be collected at the
time of service. We will do our best to provide accurate estimates for co-pays, but please understand that our
estimated benefits are not a guarantee of payment from the insurance company and may vary from actual payment
received. We will send in all insurance claims and the insurance will send their payments directly to our practice.
You will be billed for any balance after the insurance plan pays on the claim. You will have 30 days once you
receive a statement from our office to remit any remaining balance.
Pre-treatment Authorization: Some insurance companies recommend an estimate of the work to be done and the
fees to be charged before determining their benefits to you. If so, we will provide you with the pre-treatment fee
estimate. In this case, it will be up to you to determine if you wish to proceed with treatment before the insurance
benefit is determined.
We recognize that under some circumstances an account balance may be incurred. Smiles Pediatric Dentistry
requires that all outstanding balances be paid in full within thirty (30) days unless other arrangements have been
made. Also note, if we have not received payment or you have not contacted us within thirty (30) days, further
action may be taken with a collection agency or with Small Claims Court. Thank you in advance for your
Your understanding and cooperation are greatly appreciated! You are helping to keep our overhead expenses down and your fees as low as possible.