OUR

PAYMENT &

FINANCIAL

POLICIES.

OUR PAYMENT
& FINANCIAL
POLICIES.

To avoid possible misunderstandings regarding payments for services rendered, we are providing you with this statement of our financial policy.

If you have questions or concerns about our payment policies, please do not hesitate to ask our office staff.

To avoid possible misunderstandings regarding payments for services rendered, we are providing you with this statement of our financial policy.

If you have questions or concerns about our payment policies, please do not hesitate to ask our office staff.

For your convenience, our office accepts cash, personal checks, and Visa, MasterCard, and Discover credit cards for services.

For your convenience, our office accepts cash, personal checks, and Visa, MasterCard, and Discover credit cards for services.

  • In the event that you do not have dental insurance, we ask that payment be made in full at the time services are rendered.

  • Most dental insurance plans do not cover 100% of the cost of your treatment. Because of this, you will be asked to pay your co-insurance/co-payments and any deductible the day services are rendered.

  • We will estimate as closely as possible your coverage, but until we actually receive payment from your carrier, it is just that- an estimate. If we do not receive payment form your carrier within 60 days, the entire balance is due from you.

  • Please understand that we file and accept assignment of your insurance benefits as a courtesy to you. If your insurance denies coverage or does not pay for any reason, you are ultimately responsible for any and all charges incurred in our office.

  • Balances older than 90 days will be subject to collection proceedings. If it becomes necessary to effect collections of any amount owed on this or subsequent visits, the patient will be responsible to pay for all costs and expenses, including reasonable attorney fees.

  • Returned checks will be subject to additional collection fees assessed by the bank.

  • Financing is available with CareCredit. Applying for CareCredit is fast and easy and you’ll get a credit decision immediately. Apply online at www.carecredit.com or call 1-800-365-8295.

NEED TO MAKE A PAYMENT?

NEED TO MAKE A PAYMENT?

DECORAH

563.382.4302

511 W Water St., Ste. C
Decorah, Iowa 52101

LANSING

563.538.4673

267 Main Street
Lansing, IA 52151