Our Fees
Our UCR (Usual, Customary and Reasonable) fees are established by
our long-term participation with Delta Dental Plan of California.
The fees are submitted and approved by Delta Dental annually on the
basis of the fees established and used by other participating
dentists in our same geographic area.
The majority of our patients have PPO dental plans that have a fee
schedule somewhat lower than our UCR fee schedule, and upon
receiving care with us as a participating provider, will generally
have a lower out-of-pocket cost for each procedure.
Please let us know if you have any questions about our fees for
specific procedures and services, as well as the provisions of your
dental plan. In most cases, we can submit your
treatment plan electronically for a pre-estimate of benefits.
In most cases, this information can also be obtained via telephone
inquiry during normal business hours.
Insurance Plans
We participate with the following dental indemnity and PPO
plans:
Aetna Dental Plan
AmeriPlan Dental Care
American Dental Network
Ameritas
Blue Cross
Blue Shield
Careington
CDN
Conneticutt General
Delta Dental Plan of California
Dental Benefit Providers
Dental Health Alliance
Dental Plan Administrators
Dentemax
Diversified Benefits Group
First Dental Health
Foundation Health
Gena Connection Dental
Great West Care
Guardian
Humana Dental
Mass Mutual
Met Life
Metropolitan
MIDA
Mutual of Omaha
Mutually Preferred Dental
One Health Plan
Pacific Union Dental
Pacificare
Phoenix Home Life
Preferred Dental Advantage
Preferred Dental Health
Premier Access
Principal Financial Group
Principal Mutual
Protective Dental Advantage
Prudential
Signature PPO Network
Smile Saver
TDC Dental Companies
The Phoenix
The Travelers
United Concordia
United Dental Care
WellPoint Dental
Financial Policy
OFFICE AND FINANCIAL POLICY STATEMENT
Welcome! We are here to serve your dental needs and those of your
family. After your examination and consultation you may have
questions about the proposed treatment. Please discuss your dental
health with us. An informed patient is a more relaxed
patient.
Your dental appointments will be scheduled at a convenient time and
date. SHOULD YOU NEED TO CHANGE OR CANCEL YOUR APPOINTMENT, PLEASE
CONTACT THE OFFICE AT LEAST 24 HOURS IN ADVANCE to avoid being
charged $75.00 per missed appointment. This is part of our policy
and allows us to maintain our lower fees. Because of
unscheduled emergency appointments the doctors sometimes run late.
This is not true for hygiene (cleaning) appointments. However, a 10
minute grace period for hygiene appointments will be permitted
before the appointment is considered failed. We are not a
large clinic and we do staff and reserve time specifically for
you!
Payment for care is due at the time services are rendered. Our
office accepts cash, checks or, for your convenience, Visa,
MasterCard, Discover and American Express. We can offer
several alternative payment plans to you and will explain them to
you more fully after your examination. We can also assist in
obtaining a special ( "Care Credit") financing card. We are
happy to file insurance claims as an additional service to you,
crediting insurance payments to your account. All remaining
unpaid insurance balances are due in full within 60 days of
treatment.
HEALTHY TEETH - STAYING HEALTHY
Most insurance companies limit the number of prophylaxis (cleaning)
to one every six months or twice in any given year. If the
dentist should recommend additional prophylaxis, there may be a
charge to you. It is the responsibility of the patient to check and
be aware of any additional charges prior to treatment.
I HAVE READ THE ABOVE STATED OFFICE AND FINANCIAL POLICIES, AND
I UNDERSTAND THAT I AM REPONSIBLE FOR PAYMENT OF ALL DENTAL
SERVICES. IF I CARRY INDEMNITY TYPE INSURANCE I UNDERSTAND THAT
THIS OFFICE WILL PREPARE MY INSURANCE FORMS TO ASSIST IN MAKING
COLLECTIONS FROM MY INSURANCE COMPANIES AND WILL CREDIT SUCH
COLLECTIONS TO MY ACCOUNT. I UNDERSTAND THAT I WILL BE
FINANCIALLY RESPONSIBLE FOR ANY FEE NOT PAID BY MY INSURANCE
COMPANY OR NOT PAID WITHIN 60 DAYS OF THE SERVICE BEING RENDERED.
FOR THE DENTAL INSURANCE PLAN, THE OFFICE WILL ASSIST IN
DETERMINING ELIGIBILITY AND I AM RESPONSIBLE FOR APPROPRIATE
CO-PAYMENTS OF ALL DENTAL SERVICES. I UNDERSTAND THAT EACH
DENTIST IS AN INDIVIDUAL PRACTITIONER AND IS INDIVIDUALLY
REPONSIBLE FOR THE DENTAL CARE RENDERED TO ME. I ALSO UNDERSTAND
THAT NO OTHER DENTIST OTHER THAN THE TREATING DENTIST IS
RESPONSIBLE FOR MY TREATMENT.
Our staff will ask you to sign a copy of this financial policy when
you register as a new patient. If you have any questions or
concerns regarding our fees or your financial arrangements for your
dental care, please let us know prior to having your treatment
provided.
Thank you!
Richard A. Harder, Jr., D.D.S.
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