It is very important that you read this document carefully!
If you are covered by dental insurance, we will, at the time services are rendered, bill your insurance provider as a courtesy to you. We will collect payment in full for the treatment to be rendered. Any payment received by your dental insurance will be reimbursed to the patient directly or can be kept as a credit on account to be applied for future treatment.
We are not a provider for Medicare, or any other medical insurance. Medicare will not pay for any procedure that is performed by Dr. Burlingame and/or Dr. Suarez and the cost is due in full by you, the patient, at the time services are rendered.
If you are a cash paying patient, payment is due on the day of your treatment surgery. There are no exceptions.
For extensive surgeries, such as full mouth extractions or facial trauma surgery, 50% of the cost of your procedure is due at the time of your consultation if you elect to schedule the procedure with our office. The remaining 50% is due on the day of surgery. There are no exceptions.
We do not offer an in-house payment plan. You may inquire about Care Credit or Sunbit options if you would like to establish a dental/medical line of credit to pay for your visit. This must be arranged prior to your treatment time. Past due accounts are sent immediately to collections.
We ask that you sign below as an acknowledgment that you have read and understand our financial policy. This policy is effective December 1, 2009.
By signing, I acknowledge that I have read the above Financial Policy and agree to the terms as stated above.