Financial Arrangement Agreement:
We strive to offer payment options for services as convenient as possible while at the same time maintaining operation of our office in the highest standard of comprehensive care. At the onset of your treatment, we will provide you with an estimate of the total fees expected.
Please understand that it will be an estimate only. Should the need for additional treatment arise during the course of the original treatment plan, the total fees could change. Please be assured that we will notify you of any change in the total fee and obtain your approval prior to proceeding with treatment. Anytime we supply an estimate, this does not guarantee the amount your insurance company will pay toward your treatment (See Plan D below).
You can pay for your office visits and any treatments by cash, check, credit or debit card at the time of treatment.
Please take a moment to review the current financial options available through our office. Should you need assistance with financial options at any time, my staff will be available upon your request.
- Plan A: Payment in full on the day of each visit with cash, check, or credit card. To demonstrate our appreciation for patients, who are prompt with full payment, we will extend a five percent (5%) reduction of the total fee. We will gladly supply you the information to submit your insurance claim. We also offer a 10% courtesy for self-paying patients with no dental insurance.
- Plan B: Payment can be made in installments for patients who qualify. You can begin your treatment with an initial down payment of only fifty percent (50%). The remaining balance is divided into two monthly installments. Special arrangements can be made with our Office Manager to extend the installment period.
- Plan C: Long-term financing is available for patients who qualify. Payment can be made through a loan company that specializes in financing dental care. Please see our receptionist for more details and to receive a loan application.
- Plan D: For patients with insurance plans, we are happy to process your primary insurance claim as a service to you at no additional charge. If necessary, we will submit a pre-determination of benefits request to your insurance carrier prior to treatment. This allows us to obtain an estimate of your dental benefits and the amount your dental plan expects you to be responsible for. All treatment that your insurance plan does not cover and the amount they expect you to pay will be due on the day of treatment, unless other arrangements have been made. Please be aware that we can not guarantee this estimate and that there may be a balance after insurance pays. Keep in mind that any estimate we provide you with is an estimate and you are responsible for the fees in their entirety.
In order to help keep costs down for our patients, we no longer file secondary insurance claims. We have found that secondary claims can be filed up to a year with little to no payment. This has created much confusion and costs to both the patient and the office.
We will be happy to supply you with the information you need to submit a secondary claim. You are responsible for mailing in the secondary claim to the insurance company and tracking your reimbursement. Again, the remaining balance after the primary insurance has paid is your responsibility.
Again, please feel free to contact the office to assist you with any questions regarding the payment option plans described above.
General information about insurance plans: Insurance plans are based upon a contract between your employer and the insurance company. Any dollar amount a plan reimburses for dental services is determined by the benefit plan that your employer has selected. If there are any problems or questions, please contact your insurance company or human resource department.
In order to keep your account in good standing, we request that a payment or payment plan be established at the time services are rendered. We utilize the services of a collection agency when accounts becomes 60 days past due. Additional charges may be incurred by the agency and according to the North Carolina State Law you will be responsible for the fees as well. To clear an account that has been sent to the collections agency, contact Interstate Credit Collections at 336-777-3524.
No-Show and Cancellation Policy:
Your visit has been reserved for you. 48 hour notice is required for cancellation or you will be charged a late cancellation fee of $75.
Please contact the office and you will be directed on how to contact Dr. Pinyan if the Emergency is after hours. If Dr. Pinyan is out of town, there will be a local dentist to cover call. Again, call the office and there will be a detailed voice mail message on how to reach the dentist covering call.
There is an after hour fee if the emergency necessitates opening the office in addition to treatment.