ACCOUNT AND PATIENT TERMS AND CONDITIONS
Patient Information forms can be filled out at the time of your first appointment in our office, and for your convenience we also offer the option of completing the Patient Information form for online submission. By completing the online New Patient Chart and Information form, and by clicking on 'Yes, I agree', you are agreeing to the following terms and conditions:
APPOINTMENTS - Your scheduled dental appointment time has been reserved specifically for you. Our office requires 48 hours notice if you need to cancel or change your appointment time. We understand that unforeseen circumstances sometimes require missing an appointment, however in the event that we are unable to fill your reserved time, you may be charged a missed appointment fee. Please phone us at 250-380-6655 or email us to re-book or change your reserved time.
We make efforts to remind patients of appointments by phone calls, email, and post cards, however these are a courtesy and your appointment is kept for the reserved time even if you do not receive a reminder. It is up to you to remember and keep appointments.
CONSENT TO TREATMENT - You consent to the diagnostic procedures and treatment by the dentist necessary for your proper dental care. You consent to the dentist’s use and disclosure of your records (or your minor child’s) to carry out treatment, obtain payment, and all activities and health care operations related to diagnosis, treatment, or payment of account. Your consent to disclosure of records shall be in effect until revoked in writing. You attest to the accuracy of the information on this dental records, and you agree to update as necessary, including health, insurance, and contact information.
PATIENT PAYMENTS - Payment is due at time of service. For work done through multiple appointments, we require 50% payment at first appointment, and balance is to be settled when treatment is completed.
INSURANCE - Our office is committed to helping you maximize your insurance benefits. Insurance policies vary and are subject to change, and because of this we can estimate your coverage in good faith, but cannot guarantee coverage due to the complexities of insurance contracts. Due to the Personal Information Privacy Act (PIPA), many insurance companies will not provide information to dental offices about plan information and coverage details. We ask you, at the time of your appointment, to provide us with your insurance carrier's information and their exemptions. The amount paid by your insurance company may be affected by annual limits, reduced coverage for certain procedures, and/or the ability to deny coverage at any time, and we may not know this at time of treatment. Your insurance contract is between yourself and your insurer and it is your responsibility to know your coverage (see Dental Insurance for information on plan coverage details).
Your estimated patient portion is payable to our office at the time of service. We may be able to direct bill your insurance plan, depending on your insurance coverage. For direct billing we will work with your insurance carrier for up to 60 days to receive payment to our office. After 60 days you will be responsible to pay the entire outstanding balance; at this time we can resubmit the claim to your insurance company for your reimbursement.
Some insurance plans will only pay the subscriber (you), and will not pay the dental office, and in this case it will be necessary to bill you at time of treatment. We are unable to bill to any insurance company if we do not have full details, including Insurance Company Name, Policy or Group Number, and ID or Certificate Number, or if we cannot verify current and active coverage. We cannot direct bill out of country insurance plans, but will provide details and forms for your reimbursement. We are not responsible for refusal of payment, any charges or treatments your plan does not cover, or any differences in fees between those of our office and those paid by your insurance plan. Please be aware of plan limitations and understand that our primary interest if your dental health. Our dentists and staff present treatment plans based on what is best for you, although we try to be aware of your insurance coverage and work within plan limitations, this is not always possible. We work for you, not your insurance.
EMERGENCY TREATMENT - We may be able to see patients for emergency and single visit treatments, depending on our dentist's appointment availability. We require full patient at the time of treatment, and for those patient's with insurance we will gladly submit to your insurance company for your reimbursement.