TO OUR PATIENTS
Subject: Medical/Dental Insurance Coverage & Notice of Privacy Practice
This notice is to advise you of the fact that you may have Medical/Dental insurance, which may not guarantee coverage, paid by the insurance carrier for all procedures provided for in this office. There is no way that this office can determine in advance what will be covered or what amount.
Before proceeding with treatment, we want to tell you as the patient receiving the services that you are responsible for all charges billed to you by this office and not paid for by your insurance coverage. Any charges not paid are subject to collection and you will be responsible for all costs of collection brought by this office against you, including interest and attorney fees provided by law.
We wish this was a better and clearer situation, but unfortunately we too are at the mercy of the insurance companies.
This form, NOTICE OF PRIVATE PRACTICE presents the information that federal law requires us to give our patients regarding our privacy practices.
This notice is a pdf document which requires the Adobe Reader software. You most likely already have this software on your computer. However, if you have difficulty reading the notice, please click here to install Acrobat Reader.