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Brush Pediatric Dentistry Financial Policy

Thank you for choosing our office for your child’s dental needs. Regular dental care is necessary to maintain a child’s medical and psychological well-being. We have outlined our financial policy for your benefit and understanding and in an effort to eliminate confusion or misunderstanding. We do our absolute best to help you understand and estimate your insurance benefits. Please note that treatment plans change on occasion during the course of treatment because conditions can worsen or improve and can therefore change your financial responsibility in either direction. We are always available to answer your questions and/or assist you in any way we can.

Without Dental Insurance

Fees are due and payable at the time treatment is rendered if you do not have insurance coverage. We accept cash, personal checks, or credit cards (MasterCard, Visa, and Discover).

With Dental Insurance

As a courtesy, our office will verify your insurance with your insurance carrier so long as you provide us with your up-to-date and correct insurance information no less than 2 business days before your child’s appointment. Our software system then estimates what your insurance will pay. We will then take the time to file the necessary forms to help you receive full benefits of your coverage. Your portion of fees, including fees that are paid directly to you by your insurance company, will be due at the time of service. Keep in mind all insurance companies include a disclaimer stating verification does not guarantee payment. Due to the thousands of insurance plans we ask that you know your benefits for it would be impossible for us to know them all. Each insurance plan is unique in what services they will allow. Insurance is an agreement between you and your carrier. If we do not receive your insurance information from you in the time frame stated above, we cannot guarantee that we will be able to process your claim and you will then be responsible for your balance at the time of service. We will then provide you with the necessary information to submit to your insurance for any possible reimbursement.

Payment Options

Prepayment Courtesy: We are happy to offer a 5% courtesy discount for all treatment over $600 that is paid in full with cash or a check prior to the time of service. This discount cannot be combined with other discounts.

Payment as Services are Rendered: Your copay is due at the time services are rendered. Because your insurance company makes no guarantee of payment, we cannot always guarantee your exact insurance coverage. Therefore, you may receive a statement with an additional balance after your insurance has met their obligation. We ask that your portion be paid at the time of service or within 15 days of receiving such statement. We also realize that some families are in a state of change and on occasion the question of who is responsible for the bill is uncertain. Ultimately, the parent who requests dental services will be responsible for the fees incurred.

Interest-Free Credit Line: Should you be interested in a payment plan, our office utilizes CareCredit and can charge your balance to CareCredit for 6 or 12 months interest free on treatments plans in excess of $200. We require that you complete a CareCredit application and be approved for a line of credit at the onset of your treatment. Please ask for more information about Care Credit.

Extended Payment Plans: CareCredit offers 24, 36, 48 and 60 month payment plans with competitive rates and no pre-payment penalty. We require that you complete a CareCredit application and be approved for a line of credit at the onset of your treatment. Please ask for more information about Care Credit.

Outstanding Balances: Because we do not want to cause any further unnecessary financial burdens to families with balances, it is our policy that any outstanding copays be paid in full. A finance charge will be assessed and appear on your statement once your account is deemed delinquent. Delinquent accounts will be turned over to a collection agency after 90 days, which may adversely affect your credit rating.

Other Details of our Financial Policy: A fee will be applied to your account for each broken appointment with less than 2 business days notice, except in case of illness or true family emergency. The fee will be determined based on the type of appointment and amount of time reserved with a dentist. A $50 charge will be made for any returned checks.

I understand that any insurance estimate given to me by this office is not a guarantee of actual insurance payment. I also understand that I am ultimately responsible for all charges incurred for dentistry performed upon my dependents in this dental office and that it is my responsibility to notify the office of any changes in my insurance.

911 N. Elm Street, Suite 228, Hinsdale, IL 60521 USA
Dr. Mira Albert Pediatric Dentist (630) 504-2223 (630) 504-2229