GOT AN HOUR? Get a Whiter Smile!
May God's Love Shine Brightly Through Lighthouse Family Dentistry
John 14:6 “I am the way, the truth and the light”
New Patients Will Receive,
*Free Take Home Tray Whitening System
($425 Value!)
*(Doctor must assess patient)
-or-
All New Patients 50% Off
Sapphire One-Hour Whitening
(Schedule within 30 days to receive offer)
Office visit Includes Take Home Tray Whitening System
Payment Options
Thank you for choosing Lighthouse Family Dentistry!
We are committed to providing you with the best possible care. If you have any questions regarding our fees for treatment, we are happy to discuss them with you.
LIGHTHOUSE FAMILY DENTISTRY
37 OLD SOLOMONS ISLAND RD.
ANNAPOLIS, MD. 21401
410-224-4411
OFFICE FINANCIAL & INSURANCE POLICY
Thank you for selecting our office as your dental health care provider. My staff and I are committed to your treatment being a positive experience. Please understand your financial obligation is considered part of your treatment. Our staff can tell you the approximate fee before your treatment is started. The following is a statement of our financial policy:
Self Pay Accounts (without Dental Insurance): We also offer great payment plans with Care Credit. (Requires Pre-Approval). Payment is due at time of service. We accept Cash, Checks, Visa, MasterCard, Discover, and American Express.
Insurance Accounts: Patients with dental insurance are required to pay their Deductible and estimated co pay at time of service. We will file your claim as a courtesy and accept assignment of benefits after confirming your coverage. If coverage cannot be confirmed, we do require FULL PAYMENT at time of service.
The normal procedure for processing claims:
- Patients should bring necessary dental insurance claim form and insurance booklet or card to verify coverage. Faxing the information prior to dental appointment is suggested to avoid problems.
- Once insurance pays their portion to us, you may receive a final statement. Payment is due in full upon receipt of statement.
*BILLING FEES: Any patient who has not paid the amount due will be subject to a billing fee of $5.00 per monthly statement.
*FINANCE CHARGES: Any patient with an account in the 30 days past due will incur a 3% monthly interest charge.
*DELINQUENT ACCOUNTS: Any accounts over 90 days from date of service will be turned over to a Collection Agency. I agree to pay all court costs, attorney’s fees and collection agency fees.
*BROKEN or FAILED APPOINTMENTS: We call to confirm appointments as a courtesy to our patients. Your scheduled appointment has been reserved at your request. Cancellations with less than 24 hours notice or broken appointments will result in a fee of $15.00 ($60 per hr) for every fifteen (15) minutes of time allotted and /or denial to reappoint. Please help us avoid charging a fee by keeping your scheduled appointments.
*MINOR: The patient or guardian must accompany a minor (age 17 or younger) for all appointments and must remain in the office while treatment is being rendered and sign our consent form.
*If at any time you have a question about this FINANCIAL & INSURANCE POLICY or your account, please do not hesitate to contact a member of our staff for assistance. However, it is the final responsibility of the patient to know what his/her insurance plan covers and how it works. We can help explain specific questions you may have.
lnk