General:
Understand that regardless of any insurance status, you are responsible for the balance due on your account. You are responsible for any and all professional services rendered. This includes but is not limited to: dental fees, surgical procedures, tests, office procedures, medications and also any other services not directly provided by the dentist.

Broken Appointments:
Unless we receive notice of cancellation 24 hours in advance, a $50 no-show fee will be added to your ledger. Please help us serve you better by keeping scheduled appointments. The keeping of an organized and prompt schedule is our responsibility to you, and we hope you can help us in achieving this goal.

Insurance:
Please remember your insurance policy is a contract between you and your insurance company. We are not a party to that contract. As a courtesy to you, our office provides certain services, including a pre-treatment estimate which we send to the insurance company at your request. It is impossible for us to keep track of every aspect of your insurance as there are hundreds of policies held by patients of this practice alone. It is up to you to contact your insurance company and inquire as to what benefits you are entitled to based on your insurance contract. If you have any questions concerning the pre-treatment estimate and/or fees for service, it is your responsibility to have these answered prior to treatment to minimize any confusion on your behalf. Please be aware some or perhaps all of the services provided may or may not be covered by your insurance policy. Any balance is your responsibility whether or not your insurance company pays any portion.

Payment:
Full Payment is due at the time of service. If insurance benefits apply, estimated copayments and deductibles are due at the time of service, unless other arrangements are made. We accept cash, checks made payable to Seneca Ridge Dental, and all major credit cards. We also accept online payments for outstanding balances if a valid email address is on file with our office.

We ask that you read, understand and sign this statement of the financial policy prior to undergoing dental treatment. If you have any questions about the aforementioned statements, please do not hesitate to ask Dr. Cappuccio or any of the staff members such that your concerns can be addressed.

Sincerely,
Dr. David Cappuccio

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