Bright Smiles is committed to providing you with the best possible care, and we are pleased to discuss our financial policy and professional fees with you at any time. Your clear understanding of our Financial Policy is important to our professional relationship. Please ask if you have any questions about our fees, financial policy or your responsibility. All patients must complete our Patient Information Form before seeing one of our dental professionals. Full payment is due at the time of service.
Payment methods accepted:
Adult patients are responsible for full payment at the time of service.
Minors Accompanied by an Adult
The adult accompanying a minor, his/her parents or guardians, are responsible for full payment at the time of service.
The parents or guardians are responsible for full payment at the time of service. Non-emergency treatment will be denied unless charges have been pre-authorized to an approved credit plan or to VISA, MasterCard, Discover or American Express.
Bright Smiles provides insurance company billing as a courtesy to our patients. The patient portion of particular dental service(s) is estimated and due at the time of service. This amount may be subject to adjustment when the dental service(s) claim(s) are adjudicated by the insurance company. In addition, certain insurance companies have annual limitation for the amount of dental services that can be reimbursed within each plan year. If you or your family exceed these annual limitations in any plan year, you will be responsible for the full amount of dental services that exceed the particular plan’s limitations. The patient is responsible for monitoring the amount of his/her remaining benefits for any annual benefit period. The patient may not rely upon any information provided by Bright Smiles staff regarding his/her remaining benefit in any such benefit period.
The claims we submit to insurance companies indicate that you have assigned those benefits to Bright Smiles. However, if the insurance company pays you directly (instead of Bright Smiles), you then become responsible for the total account balance and payment would be expected immediately. If you or your family has more than one dental insurance program, we will assist you in obtaining the maximum benefits available. You, as a patient, are always responsible for any charges that are not covered by your insurance.
If you are covered by Medicare, Medicaid, Champus, Workers’ Compensation or any other government sponsored program, please discuss your payment situation with our office staff prior to date of service.
It is our policy to charge finance fees at 1.5% for outstanding patient balances after the balance has been outstanding 30 days. In addition, all payments returned due to non-sufficient funds will be subject to a NSF fee of $35.00.
When you make an appointment, we reserve that time especially for you. If you must cancel or change your appointment for any reason, we kindly request you to give us a 48 hours notice. Unless cancelled at least 48 hours in advance, our policy is to charge for missed appointments at the rate of $50.00 per each 30 minutes of missed appointment time. Please help us serve you better by keeping your scheduled appointments.