Terms and Conditions
One time setup fee of $25.
$25/month for the duration of the contract for adults.
$16.50/month for the duration of the contract for children 13/younger.
Patients must sign up for an automatically renewing contract. You must remain in the plan and pay membership fees for a minimum of 12 months.
Payment of less than 12 months’ membership fees may result in being charged usual and customary fees for all services (including those already provided) and being charged remaining months’ fees in lump sum.
Patients must stay the duration of the contract but can discontinue on their plan anniversary upon written notice to the practice.
Fees for dental services are due as services are rendered.
Fees for prosthodontics and cast restoration services are due at the preparation/impression visit. Failure to comply may result in my being charged usual and customary fees for such services.
Minor Services are defined as any direct composite or alloy restorations as defined by Current Dental Terminology [CDT] codes D2110-D2394. Major services include but are not limited to any other CDT codes including crowns, fixed partial dentures, extractions, dental implants, orthodontics.
You must agree to pay any and all costs in collecting all charges. Including but not limited to attorney fees and court costs. Coverage must be continuous. Missing monthly payments must be made up for interrupted coverage. Last month fees are not refundable.
DENTAL LIMITATIONS AND EXCLUSIONS
1) Demonstrated non-compliance with recommended course of treatment.
2) Services which in the opinion of the attending dentist are neither necessary nor recommended for the patient’s dental health.
3) Dispensing of drugs not normally supplied in a dental office.
4) Services for injuries or conditions which are covered under Worker’s Compensation or Employer’s Liability laws.
5) General anesthesia/Conscious Sedation
6) Services that cannot be performed because of the general health, physical or psychological limitations of the patient.
7) Plan Participants cannot have other dental coverage.