Finanzas

Nos complace que haya elegido a Professional Dental como su proveedor dental. Aceptamos muchos seguros diferentes para beneficiar a nuestros pacientes. Como condición para su tratamiento en esta oficina, se deben hacer arreglos financieros por adelantado. Esta práctica depende del reembolso de nuestros pacientes por los costos incurridos en su atención, para seguir siendo viable. Por lo tanto, la responsabilidad financiera por parte de cada paciente debe determinarse antes del tratamiento.

Patients who carry dental insurance understand that it is their responsibility to provide correct/updated insurance information. All dental services rendered are charged directly to the patient and that he or she is personally responsible for payment of all services. Professional Dental is happy to submit insurance forms and help resolve outstanding claims to the insurance company designated by you. You must understand that not all insurance companies pay in full for estimated services rendered. However, regardless of insurance coverage, I agree that it is and shall remain my responsibility to pay all amounts owing as set forth herein.

I agree that interest will accrue on all past-due amounts at the rate of 18% per annum (1.5% per month) until paid in full. In the event any amount(s) is/are referred to a third party debt collection agency, I agree that in addition to any other amount(s) allowed for by law, (such as interest, court costs, reasonable attorney’s fees, etc.) I will also be responsible for a collection fee of up to 40% of the principal amount(s) owing as allowed by Utah Code Annotated, sec.12-1-11. The terms of this paragraph shall apply to all amount(s) incurred by me or by any individual for whom I have legal responsibility whether such amount(s) are incurred today or after today.

Por la presente doy mi consentimiento para ser contactado por teléfono a cualquier número de teléfono (incluidos, entre otros, números de teléfono inalámbrico/celular) proporcionado por mí o cualquier persona asociada conmigo o que actúe en mi nombre a Professional Dental o cualquier persona que actúe en su nombre. Entiendo y acepto que dichas llamadas pueden ser iniciadas por Professional Dental o cualquiera de sus afiliados, agentes, contratistas o cesionarios, incluidas, entre otras, empresas de facturación y/o agencia(s) de cobro de terceros, y que los métodos de contacto puede incluir el uso de mensajes de voz pregrabados/artificiales y/o el uso de un dispositivo de marcación automática y/o el uso de mensajes de texto, algunos o todos los cuales pueden resultar en cargos de datos. También doy mi consentimiento para recibir correos electrónicos en cualquier dirección de correo electrónico proporcionada por mí o cualquier persona asociada conmigo o que actúe en mi nombre.

I agree that if payment cannot be made at the time of service, treatment may be denied and I am responsible for any costs incurred. I agree that any verbal agreement for payment is a legal agreement and I will be held to such agreements until the balance of my account is paid off.

I understand that there will be $25 charge on all returned checks. I understand that after one check is returned, the only method of payment this office can accept is cash or credit. I understand that 24-48 hours notice is required to cancel an appointment. In order to keep costs low, I agree that I must be at each appointment as agreed and scheduled. A minimum of a $60 charge will be made for broken or failed appointments.