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675 Dunsford Road
Sullivan, MO 63080
573.468.2774
Our Financial Policy

It is our goal to provide a financial option that will allow you to comfortably receive the dental services you need or desire. We are pleased to be able to offer a variety of financial options to serve your needs.

Our Financial Policy requires payment, or arrangement of payment, for services as treatment begins. For those with dental insurance, the payment due includes any estimated portion not covered by insurance (deductibles, co-payments, insurance plan exclusions or limitations, etc.). Please note that you are fully responsible for all fees charged, independent of insurance involvement. If extended payment arrangements are needed, our policy requires the use of one of our established methods:

  1. Pay-as-You-Go - Pay your financial obligation as treatment is rendered by cash, check, debit or credit card (Visa, MasterCard, and Discover).
  2. Payment-on-Hold - Pay your financial obligation in two parts: (1) 50% paid as treatment begins and (2) a final check or credit card payment.
  3. HealthCare PayPlan - Pre-authorized credit card installments.
  4. Care Credit - A credit card for healthcare services, an application is required. Click here for more information.
As treatment is recommended, a customized treatment plan will be provided for you and discussed with our financial coordinator. All financial arrangements must be made before appointment time is reserved.

At the age of 18 patients are legally and financially responsible for their own account.

Additional Information

Minors: Children under 18 must be accompanied by a parent or guardian, or have a signed parental consent form on file for treatment to be rendered. Payments for any financial obligation must be prearranged or paid in full the day of service. Under Missouri law both parental parties are legally responsible for a child's account.

Effective October 1st 2006. Pre-school age children or younger can be accompanied to an operatory by one adult only. Due to health, safety and privacy regulations kindergarten age children to adults may only be accompanied to an operatory by a staff member. Prior to or shortly after an appointment a doctor or staff member will consult with family members in regards to patient care.

Insurance: As a courtesy to our patients we will file primary and secondary insurance claims for you. We do not accept payment from third party claim administrators, such as attorney's, workman's compensation, or any liable corporation. We are also unable to file medical insurance claims. We request that payment or payment arrangements be made as treatment is rendered. It is ultimately your responsibility as the insured person to be informed of your dental insurance eligibility and coverage.

Insurance

As a courtesy to our patients we will file primary and secondary insurance claims for you. We ask that you carefully read your policy to be sure that you are fully aware of any restrictions that apply to the services provided. Please note that you are fully responsible for the full dollar amount of all fees charged, independent of insurance involvement.

Our courtesy services to you include:
  • Filing your insurance within 24 hours of your visit and requesting payment of your benefit to our office, allowing you to pay only the coinsurance the day of service.
  • Electronically filing your insurance to expedite your claim.
  • Assistance with your dental insurance plan to advise you of estimated benefits available to you.
  • Re-filing your insurance a second time at 30 days and a final time at 60 days.
  • Following the American Dental Association guidelines for coding procedures and filing insurance.
Our expectations of you as the owner of the policy:
  • Payment of fees estimated to be not covered by your insurance plan at the time the service is rendered.
  • Understanding that the insurance policy belongs to you and we have no leverage to obtain payment from your insurance carrier.
  • Taking responsibility for payment if the insurance company does not pay our office within 75 days.
  • Keeping our office informed of any changes in your insurance coverage or employment.
Underpayment/Overpayment: We estimate your portion due on the date of service based on the information given to us by your insurance carrier. Once the final insurance benefit payment has been received, we will reconcile your account and bill or refund any difference.

Our Appointment Policy

Thank you for allowing us the privilege of being your dental health provider. Our practice is dedicated to your quality care and is pleased to reserve time exclusively for you. We attempt to schedule appointments that are most convenient for you and that fit your personal schedule.

We respect our patients' time and make every effort to remain on schedule. Some visits are more complicated than initially anticipated, and emergencies may arise that could delay us. If we are significantly delayed, every effort will be made to notify you beforehand so you may choose to come later or reschedule. If you are going to be late, we ask that you please notify us. If you are significantly delayed, your scheduled treatment may be modified or you may be asked to reschedule your appointment.

We strive to create a schedule that most efficiently provides for the dental needs of all the patients we serve. Because we reserve time exclusively for each patient, we ask that you make every effort not to change your reserved dental appointment. If you find that you cannot keep your scheduled appointment, we require a minimum 24 hours notification. This allows your reserved time to be made available for other patients. To notify us of any change, please call our office during business hours or leave a message on our answering machine, which is time and date stamped for your convenience.

We understand that there are unforeseen circumstances that cause reserved appointments to be missed without 24 hours notice; we certainly want to make provisions for this within our policy. In order to make this provision, as well as to maintain the most efficient schedule for our patients, our Appointment Policy is as follows:
  • One broken appointment (without a 24-hour notification) is allowed per patient within a 6 month period.
  • Subsequent broken appointments within the 6-month period you will no longer be given pre-set appointments, but will be placed on our call list and notified as appointments become available.
Additional Information

Under 18 - Children under 18 must be accompanied by a parent or guardian, or have a signed parental consent form on file for treatment to be rendered.

Over 18 - Appointments for patients over 18 are to be scheduled by the patient.

Family - Family/Multiple Appointments are limited to 2 appointments per day. (Exceptions for families with outstanding appointment histories may apply.)

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