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(970) 565-9569
MON-FRI 7AM-2PM
43 W. Montezuma Ave.
Cortez, CO 81321
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Financial Policy
Please check each box to verify you have read and understand our financial policy.
PATIENTS WITH DENTAL INSURANCE:
Be prepared to pay your estimated portion of the dental fees at the time of service. Once we receive payment from your insurance company we will send you a statement showing their payment and your remaining balance.
We bill all insurance companies as a courtesy to you, but are contracted with Blue Cross and Blue Shield, Dental Dental only. We will help you collect the insurance funds that are due to you - however, should they refuse to pay, the balance is your responsibility.
PATIENTS WITHOUT DENTAL INSURANCE
Payment in full is due at the time of service. For treatment that requires more than one appointment (such as a crown or bridge) you may make two payments, one at each appointment, given that the first payemnt covers at least half of the full amount due. We offer a 5% discount to those who pay in full, with a check or cash, on the date of service.
FINANCIAL POLICY FOR ALL PATIENTS
We bill monthly statements, up to 3 months. If payment is not received in full within 120 days, your account will be turned over to our billing agency, AR Services. Please further understand that a finance charge of 1.5% per month will be added to any overdue balance.
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Should your account be sent over to our billing agency, you are responsible for and agree to pay to pay all resonable costs of collection or attorney fees.
A $30 fee may be assessed for returned checks.
If a dental bill continues to go unpaid without a payment plan, further treatment may be refused.
We accept Visa, Mastercard, and Discover for your convenience. We offer financing with CareCredit with no interest up to 6 months, as well as extended payment plans for those who qualify.
We offer a 5% senior citizen discount for those over the age of 65.
BROKEN APPOINTMENTS
We encourage all patients to keep their appointments. If you must change your appointment, we require at least 24 hours notice to avoid a $25/hour cancellation fee (emergencies are an exception).
AFTER HOURS EMERGENCIES
In the event of an emergency after regular business hours a $150 emergency fee will be charged in addition to the necessary treatment fees.
By signing below, I acknowledge that I agree and accept the financial policy as outlined. I authorize and request my insurance company to pay directly to the dentist all benefits. I understand that my dental insurance carrier may pay less that the actual bill for services. I agree to be responsible for payment of all services provided on my behalf or my dependents.
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