Financial Policy

The doctors and staff of this practice are proud to be part of a team whose primary objective is to deliver the finest and most comprehensive dental care available today.  In addition, we are dedicated to making your care as cost effective as possible.  Please read and sign this form to acknowledge that you understand and agree to the following: 

All patient balances are due at the time service is rendered, unless we have agreed to submit to your dental insurance.  We are participating providers with Delta Dental of MA (Premier) and BlueCross and BlueShield of MA (Dental Blue).  Patient balances after insurance are due within 30 days of statement.

All unpaid balances over sixty (60) days will be subject to a finance charge of 1.5% per month or 18% per year.   We accept cash, check, MasterCard, Visa, Discover, and American Express.

A returned check fee will be applied and must be payable from you for any check payment returned to us by your bank. 

Dental insurance is a contract between the patient, their employer (if applicable) and the insurance provider.  Submitting claims to your insurance provider is a courtesy provided by this practice, not an obligation.  I understand and agree that I am responsible for any treatment or portion that is unpaid by my insurance (“patient payment”), as well as to know the benefits and terms of my policy.  Upon request, we can submit a pre-treatment estimate to your insurance to determine services covered and patient portion.  Predeterminations are NOT a guarantee of payment.

We do offer the following benefits, which may help with the cost and payment of treatment:

SENIOR CITIZENS’ DISCOUNT- 5% (Does not apply to any services covered by dental insurance.) For patients age 65 and older for dental work only (not TMJ or dental products).  Payment must be by cash or check only on date of service.  For procedures that require two or more appointments (i.e.: crowns, bridges, dentures, etc.) fee must be paid in full on the day the service is first begun.  Does not apply to credit card payments or payments made after the start date of the procedure.

CASH DISCOUNT – 5% (Does not apply to services covered by your dental insurance or any TMJ procedures.) This discount is for all patients, regardless of age, for procedures $500.00 or over. Must be in the form of cash or check only and must be paid on the day the procedure is begun. Account must have a zero (0) balance for this discount to be allowed.

CARE CREDIT FINANCING – Our office offers a CARE CREDIT promotion of zero down payment and no interest for six months. There are no annual fees or prepayment penalties. This is a third party financing company. Applications can be done online or over the phone. Brochures are available at the front desk. 

DISCOUNTS CANNOT BE COMBINED AND SOME RESTRICTIONS MAY APPLY.