We make every effort to provide you with high quality oral surgery care and convenient financial options. If you do not have insurance coverage, payment is due in full on the day of your surgery. For your convenience we accept most major credit cards. We also accept cash and personal checks. Financing programs are available through Care Credit, Lending USA, and Proceed Finance.
As a courtesy to you, if you provide us with insurance information, our office will file a claim with your insurance company. We will do our best to get whatever payment is allowed by your insurance for your care. To accomplish this goal, we will work very closely with you to maximize your insurance reimbursement for covered procedures. Please keep in mind that not all services are a covered benefit in all contracts.
PLEASE BRING ALL MEDICAL AND DENTAL INSURANCE CARDS with you to the initial appointment so that we can expedite reimbursement. If we are seeing a dependent child, we need both parents’ insurance information. Please keep us informed of any changes to your insurance plan.
Please remember that insurance is considered a method of reimbursing the patient for fees paid to the doctor and is not a guarantee or substitute for payment at time of service. Any remaining cost is your responsibility. You are responsible for the fees charged by our office, no matter what your insurance coverage may be. We ENCOURAGE you to know your insurance benefits or visit your human resources department for assistance. Most insurance companies should respond to the claim within four to six weeks. Please feel free to contact our office for further information on our financial policies.
I understand the information disclosed in this form may be subject to re-disclosure and may no longer be protected by HIPAA privacy regulations and the HITECH Act.
1111 E. Walnut St Suite B
Carbondale, IL 62901
New Patient Number: 618-300-5078
Current Patient Number: 618-529-2571
Dental Marketing by Progressive Dental