FORMS & INSURANCE INFO FOR NEW PATIENTS
New patients: Please fill out the two forms below prior to your first appointment:
Please also see below important information you should know about your dental insurance, and please have them ready for us at your first appointment:
Information required to submit your claims electronically :
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Name of insurance provider / carrier
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Plan holder's name
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Plan holder's date of birth
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Plan holder's address
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Group / policy number
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Certificate / plan ID
Information you should ask your insurance company regarding your coverage :
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Please note that payments are due in full on the day of the appointment. Our office does not accept direct billing to the insurance company.
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What is the annual maximum amount allowed per person for major / minor treatment ?
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What is the co-pay percentage for major / minor treatment ?
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What is the annual deductible ( if any ) ?
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Is the coverage based on a calendar year or on a rolling month (6 months, 12 months, etc) ?
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How many units of scaling and/or root planing are covered per year or per x rolling months ? Does the policy allow additional units ?
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What is the allowable frequency for recall exams (typically every 9 months), polish and fluoride (normally 6 months for minors, 9 months for adults) ? Note that this frequency is independent of the scaling frequency.