Insurance Payment and Warranty Information

Usually, payment for services is due at the time they are provided. However, financial considerations should not be an obstacle to obtaining dental treatment. We understand that different people have different needs in fulfilling their financial obligations. We can help arrange a payment schedule. Please see Financial Options below.

Financial Options

1. Cash, money orders and personal checks.
   Pay your obligation at each visit and receive a 5% courtesy discount.
2. MasterCard/Visa and Discover.
   Pay your obligation at each visit and receive a 3% courtesy discount.
3. CareCredit - the monthly payment plan we offer for balances of $300.00 or more. With CareCredit:
   • Approval usually only takes a few minutes
   • NO Interest Payment Plan up to 12 months
   • Low Interest Extended Payment Plan that allows more time to pay off the balance
   • No annual fees or prepayment penalties
   • Begin treatment immediately
   • Talk to Lora for an application

To apply online and find out more, go to: carecredit.com/patients/whatis.htm.

Balances Due

Balances over 90 days will incur a finance charge of 13.2% APR.

INSURANCE REIMBURSEMENT

It is our pleasure to assist you in maximizing your insurance benefit by completing your claim forms. If your carrier is capable, your claims will be submitted electronically via computer modem before the end of the treatment day! As a courtesy, in addition to filing your claims, we will initially ask you only for your estimated co-payment. Please understand that this is only an estimate, and is based upon the information available to us.

Some plans base the amount of benefit on a schedule of fees arbitrarily developed by insurance companies. For this reason, you may receive a lower percentage than the reimbursement level indicated in your dental plan. For example, if your plan states that it will pay 80% of the cost of a specific treatment, it means 80% of the fee arbitrarily determined by the insurance company, and not the actual fee charged by our office.

The financial obligation for dental treatment is between you and our office. Your insurance is a contract between you, your employer and the insurance company. We are not a part of that contract. We will assist you in any way that we can by filing your claims and working to obtain your maximum available benefits.

If you have any questions concerning the above information or are uncertain regarding insurance information, please do not hesitate to discuss it with Lora. For more information, please review our Financial Policy or any of our available Forms.

Warranty

We are confident in the excellent dental services that we provide and offer a limited warranty agreement to our patients. Our goal is not only to treat your current dental problems but also to ensure your dental health for life. We strive to work with each patient to correct conditions before they become costly and serious, preventing future dental health issues and unnecessary discomfort. The warranty agreement is offered to patients that follow a regular hygiene schedule in accordance with our recommended treatment plan.

Sealants

A sealant is a plastic material that is applied to the chewing surfaces of the teeth. This creates a barrier over the pits and grooves of the teeth and is clinically proven to significantly reduce the risk of tooth decay. Sealants will be repaired or replaced for a period of 3 years after placement.

Composites (White Fillings)

A composite is a metal-free tooth colored filling. If the composite restoration fails or breaks, Dr. Donnelly will repair or replace it for a period of 3 years after placement.

Lab fabricated crowns, bridges and veneers

We warranty these restorations for a period of 5 years. We will repair or replace them at no charge if they break or are lost. This does not include personal injury, accidents, chewing ice or non food items or intentional damage.

CEREC All Ceramic Restorations

CEREC restorations are all ceramic inlays, onlays or crowns that are fabricated in our office during a single visit utilizing CAD/CAM technology. Dr. Donnelly will replace or repair a CEREC restoration at any point up for 10 years provided that you maintain your regularly prescribed preventative (cleaning and exam) appointments.

Provisions and What is not covered by Limited Dental Warranty

1. Failure to follow your prescribed continuing care visits (3,4 or 6 months) for professional exam, x-rays and cleaning.
2. Failure to keep account in good standing.
3. Failures or damage to restorations caused by traumatic injuries, chewing ice or non food items or improper oral hygiene.
4. Failure to complete necessary gum or nerve treatments as prescribed by our office to prevent gum and tooth decay, which have a tendency to spread from tooth to tooth.
5. Cash refunds for any treatment rendered.