Financial Policy (v5.0)
for the office of Dr. Stadler DDS

It is the intent of this practice to deliver quality Dental Care for a reasonable fee. Fees are determined by the service performed at time and materials.

Payment is expected at the time of service. As a courtesy, we will process claims for Patients who have Dental Insurance Coverage. Patients must have a current and completed Dental Insurance form to include addresses and Patient signature at time of treatment. Any fees not covered or paid by the insurance carrier after 60 days become the Patients' responsibility and will be payable at that time. Secondary insurances will not be processed.

Patient's and/or guarantors are responsible for all fees regardless of insurance payment or coverage. In providing to children and adolescence, parents are responsible for the account. In cases where the parents are divorced or separated, the parent who brings in the child is responsible for the account.

Statements on accounts with balances due are sent after the 1st Friday of the month. Prompt payment is expected by the 25th of that month. Statements are sent for accounts with balances and where insurance have been paid or denied. Past due accounts will be assessed late fess of 1.5% monthly (18%APR). Delinquent accounts will be handed over to Magistrates Court or collectors. All court cost collection fees and reasonable Attorney fees will be paid by the guarantor.
Failed appointments or appointments that are canceled with less than 24 hours notice will be billed either $45.00 or $60.00

Fee discounts may be given upon full payment at time of service a long time cash patients and seniors at our discretion. This will not include credit card payments, emergency care, or prosthetics. A discount is valid only on the date of service, not applied at another date. Patients who are habitually late, fail, or cancel appointments will not receive discounts. They may also be asked to leave this Practice and to seek the services of another Dental office.

Of the utmost importance...is if you have a billing problem...please inform us promptly. We are here to help Aged insurance claims over 9 months will be researched. Insurance patients have to e knowledgeable about their insurance plan and coverage. Please read your booklets and all EO's (Explanation of Benefits) which will be sent by the insurance carrier after each dental claim that have been denied (not paid) are the responsibility of the Patient and payment due at that time.
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I have read the Financial Policy (V5.0) for the Dental Office of Dr. Stadler. I understand and agree to those policies.

Signature:____________________________  Date: ___________