Appointments
Financial Policy
Insurance
Returned Checks and Delinquent Accounts
NH Medicaid
Divorced/Separated Families

Appointments
Office visits are by appointment only. Please arrive on time for your appointments and be prepared to provide our staff with your dental insurance card(s). If you are unable to keep your appointment, please notify us at least 24 hours in advance. If we do not receive the required notice, our $25 no-show fee will apply due to our extensive waiting list. If you must be late for any reason, please call. If you arrive late for your appointment, we cannot guarantee that you will be seen. We do our best to stay on time and know the value of your time. Given the nature of our specialty, medical emergencies and unavoidable delays do occur. As these situations arise, we thank you in advance for your patience and understanding.

Financial Policy
Payment is due when services are rendered. We do accept cash, checks, Mastercard and Visa. If treatment requires several visits, we will provide you with an estimate and our Billing Manager will be happy to work out financial arrangements with you if desired.

Insurance
As a courtesy to our patients, we accept assignment of benefit on many dental insurances. Please bring your insurance card to your initial visit and to each visit thereafter.

Please be aware that your insurance may only partially cover services provided and coverage varies among insurance companies and even among employers. A 20% co-payment will be required for all restorations at the time of visit. If there are two insurance carriers, we will determine which is primary and which is secondary and will file claims accordingly.

It is your responsibility to notify us of any changes in or termination of your dental insurance coverage. We know that dental insurance coverage may be complex and difficult to understand. We encourage you to discuss questions with your insurance carrier in order to receive the maximum benefits available under your individualized plan. Since our relationship is with you and not your carrier, the final responsibility for payment lies with you. Payment for balances remaining once insurance clears is due upon receipt of the first statement.

Should your insurance carrier's policy be to send payment for services rendered to you, the subscriber, payment will be required by you at the time of service. It is your responsibility to ensure that your insurance carrier reimburse you for any payments made. For any insurance coverage for which we do not participate, we will submit a dental claim for you for reimbursement by this carrier. You must provide all pertinent information to us for the filing of this claim.

Returned Checks and Delinquent Accounts
There will be a $25 charge for all returned checks. Patients are also responsible for any additional expenses incurred in processing and collecting delinquent receipts. We employ a collection agency; any accounts greater than 60 days delinquent will automatically be forwarded to the collection agency through our computer system. This system is automatic and is not generated by this office.

NH Medicaid
We will submit your child’s claims to NH Medicaid up to age 18 as a courtesy, provided your child is eligible for coverage during his/her visit. Often there is a lapse in coverage for which the patient will be responsible for all fees incurred during that time. Payment for all non-covered services by NH Medicaid will be the responsibility of the patient. Some of these “non-covered” services include cleanings more frequently than every 6 months and fluoride treatment for patients over the age of 12. NH Medicaid allows ONLY ONE periodic oral exam every 6 months per provider; ONLY ONE dental prophylaxis (cleaning) every 6 months; and some x-rays due to timing frequencies.

Divorced/Separated Families
Because of the difficulty of billing a third party, the parent who brings the child to his/her appointment will be financially responsible for any balances, co-pays, and broken appointment fees. It is this parent's responsibility to be reimbursed by the ex-spouse. Our office will NOT contact the ex-spouse under any circumstances. In the event that the ex-spouse fails to pay his/her share of the costs, the entire account balance must still be paid by the attending parent.

It is the parent’s responsibility to seek reimbursement via the courts system and NOT the responsibility of our office.