Welcome to Angel Dental Care.
Angel Dental Care provides quality dentistry for people of all ages. We offer a wide range of dental services, including preventive, cosmetic, restorative and reconstructive dentistry.
We pride ourselves on our patient-centered practice. We do everything possible to make dental visits pleasant for our patients. In our continuing efforts to provide comprehensive dentistry to you, our valued patients, we ask that you become acquainted with our organization policy. If at any time you have any questions, please feel free to ask our business coordinator, so that we may better serve you.
All recommended treatments are in the best interest of our patients. We will not allow insurance companies to dictate treatment; therefore we will inform you before we perform any recommended treatments. We will assist you in your payment options to help you receive the highest quality of dental care treatment that is necessary for your needs. Please note that no two mouths are alike. We customize your treatment to suit your needs.
We accept assignment of estimated insurance benefits as a courtesy to our patients. Please note that your dental insurance is a contract between you and the insurance company. It is not a contract between the dentist and the insurance company. Our usual and customary fees, which are modest with our geographical area, are a reflection of our commitment to excellence. All estimated co-pays and deductibles are due at the time of service.
All insurance claims are submitted within 24 hours. However, we have found that some insurance companies do not reimburse us within an adequate timeframe. After 30 days, we will re-submit the claim as an added courtesy to you. If the claim is still not paid 60 days later, you will be responsible for the total amount. We strongly recommend that you follow up with your insurance company to ensure prompt processing of claims.
Balances remaining after sixty (60) days may accrue interest and may be sent to a collection agency.
Angel Dental Care will not accept secondary dental insurances. We recommend that you read your policy carefully to be fully aware of any restrictions that may apply to your dental benefits. For your convenience, we may process your secondary insurance claim for you for a small fee of twenty dollars ($20) per claim.
Patients who are enrolled in any HMO dental plan (managed care dental plans), please remember that your plan offers you comprehensive treatment at a discount of our usual and customary fees. In accordance with your contract, all payments are due in full at the time of service, unless other arrangements have been made. Any treatment not covered by your plan will be charged from our usual and customary fee schedule.
In the event that insurance does not cover your treatment or is cancelled/terminated for any reason, or cannot be verified for any reason, the patient or responsible party will be responsible for the entire fee amount including the insurance portion.
Please note that our policy requires verification of insurance. In the event that we are not able to verify your insurance information, payment will be due at the time of service. We will assist you in submitting a claim to your insurance company, so that the insurance company will reimburse you directly for your visit.
We reserve appointment times especially for you and for your dental care needs. We strive to give each patient a courtesy call one to two days in advance of your scheduled dental visit. However, you are expected to keep your appointment time with or without the courtesy call. Therefore we ask your consideration and that you kindly give 48-hour notice if you are unable to keep your appointment. Please note that if 48-hour notice is not given, there may be a $60.00 per half hour for a broken appointment fee. A broken appointment is a loss to yourself, your dentist and his staff, and to another patient who could have had that appointment time. We reserve the right to terminate your relationship with our office after repeated broken appointments without 48-hour notice.
In some cases, your dentist may be running late and you will find yourself waiting to be seen. Because we accept all emergency cases as we receive the calls, sometimes the dentists fall behind because they have to incorporate these emergency patients in between the regularly scheduled patients. We apologize for this inconvenience, as we understand that everyone has a busy schedule, but we are certain that you and your loved ones would want that same courtesy of being treated when you have an emergency situation and are under severe pain. We are striving to be the “angels” of dental care by being there when you need us. Your understanding in this matter would be greatly appreciated.
Please be advised that it is our policy not to perform prophies (cleanings) when a patient has gum disease. As gum disease is a very serious problem and should be treated without delay, we feel this policy is in the best interest of the patient. Our initial visit fee includes the exam and preliminary x-rays (up to 4 PA's or 4 Bitewings only- if additional x-rays are needed you will be charged our normal per x-ray fee). There will be no refund for the initial visit fee. The following fees (which include the cleaning and the fluoride application) apply for the initial visits:
$160.00 When seen during normal business hours M-F 7am-5pm
$125.00 Children (12 and under) seen M-F 7am-5pm
$190.00 When seen after hours or on weekends
$150.00 Children (12 and under) seen after hours or on weekends
$225.00 When seen on federal holidays
$190.00 Children (12 and under) seen on federal holidays
The following fees are for Emergency visits which include 1 PA and 1 Bitewing only-if additional x-rays are needed you will be charged our normal per x-ray fee:
$95.00 When seen during normal business hours M-F 7am-5pm
$125.00 When seen after hours or on weekends
$150.00 When seen on federal holidays
Prophylaxis (Cleaning) on Initial Visit
If it is determined that there is gum disease and a cleaning is not performed, a refund of $65.00 will be given to the patient or it can be applied as a credit toward continuing care with Angel Dental Care
We require a picture ID for all patients over the age of 14 (driver's license, school ID or military ID). We also require all patients to be photographed for identification purposes and to protect you and our dental clinic against insurance fraud. Any patient who refuses to be photographed will not be seen at Angel Dental Care.
Preferred Method of Payment
For your convenience we accept Cash, ATM/Check cards and all Major Credit Cards (American Express, MasterCard, Visa, Discover), and Checks (with proper I.D.). We also use an automated telecheck service, which electronically withdraws the payment from your account or insures payment. There will be a thirty-five dollar ($35) returned check fee applied to your account in the event that the bank denies your check for any reason. Payment will be expected within 48 hours of notice from the bank, in cash or by credit card.
As an added courtesy we also offer a revolving line of credit through a third party (upon credit approval). This line of credit allows you to start treatment today and spread payments over a comfortable period of time.
For treatment plans that exceed one thousand dollars ($1000); we offer a prepaid discount of 5% when paid in full by cash, ATM/check card and all Major Credit Cards (American Express, MasterCard, Visa, Discover) and checks (with proper I.D.) before the treatment begins.
Once services are performed, refunds cannot be made for those services.
All electronic payments (VISA, MASTERCARD, AMEX, DISCOVER, ATM) will be refunded within ten (10) business days, not including weekends and holidays.
All cash and check payments will be refunded, by company check, within thirty (30) business days, not including weekends and holidays.
In the event that you should request a duplication of your dental records, you are required to fill out an Angel Dental Care release form. Please note that there are some costs incurred, therefore we require a small fee of fifteen ($15) dollars for your dental records. Payment is due upon request of duplicating services.
X-Ray Duplication Fee
In the event that you should request a duplication of your x-rays, you are required to fill out an Angel Dental Care release form. If you have insurance coverage, the insurance company will determine your fees. Otherwise, there will be a fifteen dollar ($15) charge for panoramic and a twenty-dollar ($20) charge for full mouth x-rays, five dollars ($5) for each bitewing x-ray and each single Periapical x-ray. All x-ray duplication requests require at least 48-hour notice to process. Payment is due upon request of duplicating services.
Agreement to pay
There will be a finance charge of 5% per month, one ($1) dollar minimum on all balances overdue by sixty (60) days and a late fee of $35.00 per month applied to your account. All returned checks will incur a processing fee of $35.00.
In the event that there is a default of payment on any amount due, and your account is placed in the hands of an attorney or collection agency, you will be charged an extra fee equal to the reasonable cost of the collection as well as any reasonable collection agency/attorney fees. Owed and incurred court costs are further charges that may apply.
This is to acknowledge that I have read, understand, and agree to the provisions of the above policy.
(Patient or Responsible Party