HATFIELD DENTAL CLINIC, P.C.
We are pleased that you have
chosen Hatfield Dental Clinic for your dental needs. In order to better inform
you, please read the following summary of our financial policy.
You, as the patient, are
responsible for all charges regardless of insurance coverage. As a courtesy, we
are happy to file claims with your insurance company for services rendered.
Your deductible, co-payment, and/or co-insurance are due at the time of
service. Any balance left on the account after insurance payment is received is
the responsibility of the patient or financial guarantor. After 30 days, you
will receive a statement for the balance on your account and it may show over 30
days past due because we were waiting on insurance payment.
We realize that patients have
financial needs, and we will do our best to find a solution that will work best
for you. We accept Visa, Mastercard, Discover, American Express, Care Credit,
personal checks and cash. There will be a $25.00 fee assessed for returned
checks. To keep your account in good standing, please remit payment by the due
date on the statement. Patients with outstanding balances 60 days or more
overdue must make arrangements for payment prior to scheduling future
appointments. All accounts 90 days past due will be referred to the small
Missed Appointments/Late Cancellations
Your appointment is time set aside especially for
you. Broken appointments represent a cost to us, to you, and to other patients
who could have been seen in the time reserved for you. Please call our office
24 hours prior to your appointment if you must cancel or reschedule.
Unfortunately, if the required notice is not given, a minimum fee of $35.00 will
be charged and immediately payable. Excessive abuse of this policy may result
in discharge from the practice.