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Patient Financial Policy Form

Patient Financial Policy Online Form

Patient Financial Policy Form Page

The staff at Buck Dental Health Associates would like to thank you for choosing us to provide you with exceptional dental care. We strive to build lifelong relationships with our patients. We hope the brief summary of our financial policy will provide you with the information you need. Our business office staff is available at (717) 284-2799 to answer any questions you may have so we may ensure open communication with all of our patients.


FEES:

Our fees for professional services are consistent with those in the community. An estimate of fees for proposed services may be obtained upon request and is routinely provided with consultation appointments. 


REGISTRATION INFORMATION:

To process insurance claims on your behalf, we must have your complete insurance information and your employment information. Please bring your insurance information with you and we will update and/or confirm the accuracy of this information during your office visit. It is your responsibility to inform us in a timely manner of any changes to your billing information.


If your insurance denies payment for incomplete or incorrect information, it is your responsibility to make payment in full.


PAYMENT AT THE TIME OF SERVICE:

We will bill your insurance for services. Please be prepared to pay any deductible and co-pay at the time of treatment.


If we do not hear from your insurance company: If we do not receive payment or rejection from our insurance company in a timely manner, we will transfer the balance to your responsibility. We request your assistance in following up with your insurance company to resolve any non-payment issues.


CREDIT CARDS: We do accept Master and VISA credit cards. We offer the option to pay the balance of charges due after insurance payments on your credit card. You may authorize this in advance or call our business office when you receive your statement. 


Our providers recommend care based on the patient's best interest, which is independent of insurance coverage issues.


We cannot know the benefits and exclusions of each patient's coverage. Contact your insurance company or employer for this information.


We thank you for choosing Buck Dental Health Associates as your partner for your healthcare needs. As always, providing high-quality health care to you is and remains our primary purpose.

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