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The fine print that our legal department makes us include.
- Parents who bring multiple children to the appointment may be asked to wait in the waiting area with younger children until the child being treated is finished.
- Payment for services is due at the time services are rendered. We accept cash, checks, Visa, MasterCard and Discover. Patients will be required to pay in full for their visit unless we have verified your dental benefits and coverage prior to your appointment.
- Rescheduling an apointment may be done up to 48 hours prior to your scheduled appointment without expense. You will be assessed a $50.00 fee per child for the second missed appointment, and a $100.00 fee per child for the third missed appointment, after which the practice reserves the right to dismiss patients due to repeated rescheduling or missed appointments per family.
- If insurance benefits are assigned to the doctor, you will be responsible for paying your deductible, co-payments, and co-insurance at the time of service. You are responsible for paying all charges not covered by your insurance company. Your insurance benefits are a contract between you and your employer. The amount of coverage you receive will depend on the type of the plan purchased by you or your employer, not the fees of Dr. Evangelisti’s office.
- Our office will accept assignment for only the primary and secondary insurance coverage, all additional insurance coverage must be filed by the subscriber. In cases where there is a primary and secondary insurance, we will follow the insurance company’s determination as to who is the primary and who is the secondary. We expect you to know these conditions before your visit. If the insurance company notifies us that we were given and billed the incorrect information the claims will be closed and you will be responsible for the balance on the account while you contact the insurance to resolve the coordination of benefits.
- There will be a $35 service charge for all returned checks.
- If a claim is not paid by your insurance carrier(s) within ninety days, you will be responsible for the full balance and further insurance appeal becomes your responsibility. We will be happy to provide you with a claim form so that you can follow up on your insurance claims personally.
- After 120 days, we will inform you of the delinquent account by letter and if no action is taken to clear the account any balances left unpaid will be sent to collections that are past due. The responsible party agrees to pay all related collection fees.
- The parent or guardian who brings the child for their initial visit is responsible for payment independent of what a divorce decree may state. Reimbursement must be made between the divorced parents. We will not intervene.