PATIENTS WITHOUT INSURANCE COVERAGE definition

PATIENTS WITHOUT INSURANCE COVERAGE. We provide written estimate of fees, and payment is expected at each visit for services rendered.
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PATIENTS WITHOUT INSURANCE COVERAGE. We provide written estimate of fees, and payment is expected at each visit for services rendered. MINOR PATIENTS: The parent or guardian accompanying the minor is responsible for full payment. In the case of divorced or separated parents, the parent accompanying the child is responsible for payment, without any exception. RETURNED CHECKS: A $25.00 charge applies when a check is returned by the bank. TREATMENT PLAN FEE ESTIMATES: The fee estimates for dental care can only be extended for a period of three months from the date of consultation. FINANCE CHARGES AND COLLECTION FEES: Finance charges will be applied to all balances not paid within 25 days of the monthly billing date. A late charge of 1.33% on the balance then unpaid and owed will be assessed each month until paid (16% annum). It is your responsibility to ensure your insurance company pays promptly so you can avoid finances charges. You agree to pay collection costs and reasonable attorney fees incurred in attempting to collect on this amount or any future outstanding account balances. BROKEN OR MISSED APPOINTMENTS: Appointments not kept or changed with less than 48 hours notice are considered broken. Broken appointments will be rescheduled and are subject to additional fees. Broken appointments prevent others from receiving the dental care they deserve. We take them seriously so please be considerate and inform us in advance if you need to change your appointment. FEE FOR MISSED APPOINTMENT IF 48-HOUR NOTICE NOT GIVEN: To reschedule or cancel an appointment, you must notify us at lease forty-eight (48) hours in advance to avoid a missed appointment fee of up to $50. We reserve the right to terminate professional treatment of any patient when scheduled appointments are not kept. RECORDS AND REIMBURSEMENTS: Original records including radiographs are the property of this office. If you desire we will provide you with a copy of your record or radiographs for a nominal duplication fee. CONSENT & AUTHORIZATION: In consideration for the professional services rendered to me by this practice, I agree to pay the charges for the services at the time of treatment. Fees not covered by my dental insurance will be promptly paid upon notification from this office. I have read and understood this document in its entirety, outlining office policies and financial policies of Ebenezer Dental, PLLC. Without any reservations, I agree to abide by the policies outlined herein. Name/Signature of guarantor of payment/resp...
Sample 1
PATIENTS WITHOUT INSURANCE COVERAGE. We provide written estimate of fees, and payment is expected at each visit for services rendered. MINOR PATIENTS: A parent or legal guardian must accompany all minors (under the age of 18 years) to the appointments. If the parent or legal guardian is unable to be present, we will require a letter of authorization for the person who will accompany the minor. Arrangement for payment must be made by the parent or legal guardian prior to the date of service. The parent or guardian who signs this financial agreement is responsible for full payment. In the case of divorced or separated parents, the parent who agrees to this financial agreement and who accompanies the minor is responsible for payment, without any exception. This office will not attempt to collect payment from a parent or legal guardian who does not agree to this financial agreement. RETURNED CHECKS: A $30.00 charge will be applied when a personal check is returned by the bank. We will then accept payment by cashier’s check, cash or credit card for fulfillment of the original balance and the returned check fee. FINANCE CHARGES AND COLLECTION FEES: Finance charges will be applied to all balances not paid within 30 days of the monthly billing date. A late charge of 1.0% on the unpaid balance will be assessed each month until it is paid. It is your responsibility to ensure your insurance company pays promptly so you can avoid finances charges. We understand temporary financial problems may affect timely payment of your balance. In those situations we encourage you to communicate any such problems immediately so we may assist you in the management of your account.
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Examples of PATIENTS WITHOUT INSURANCE COVERAGE in a sentence

  • PATIENTS WITHOUT INSURANCE COVERAGE: A discount will be applied at check out when treatment is rendered.


More Definitions of PATIENTS WITHOUT INSURANCE COVERAGE

PATIENTS WITHOUT INSURANCE COVERAGE. We provide written estimate of fees, and payment is expected at each visit for services rendered. PAYMENT POLICY: We accept cash, personal checks, and credit cards. If a check is used it must be the patient’s account and be signed by the patient. Third party checks are not accepted. RETURNED CHECKS: A $75.00 charge will be applied when a check is returned by the bank. Non-payment checks not reconciled will be sent to the State Attorney’s office. CANCELLATION POLICY: A fee of $100.00 will be applied if an appointment is cancelled or broken without at 24 hour notice. We reserve the right not to make future appointments if this occurs more than twice. This fee is subject to change without notice.
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Related to PATIENTS WITHOUT INSURANCE COVERAGE

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  • Co-insurance means the percentage of the usual, reasonable, customary, and fair market value expense that a covered person must pay.

  • Insurance Cover means the aggregate of the maximum sums insured under the insurance taken out by the Contractor pursuant to Article 20, and includes all insurances required to be taken out by the Contractor under Clauses 20.1 and 20.9 but not actually taken, and when used in the context of any act or event, it shall mean the aggregate of the maximum sums insured and payable or deemed to be insured and payable in relation to such act or event;

  • group insurance means insurance, other than creditor’s group insurance and family insurance, whereby the lives of a number of persons are insured severally under a single contract between an insurer and an employer or other person; (“assurance collective”)

  • Insurance means comprehensive insurance of the vehicle(s)/equipment and shall include insurance of the crew.

  • Health care coverage means any plan providing hospital, medical or surgical care coverage for

  • In-Orbit Insurance means, with respect to any Satellite (or, if the entire Satellite is not owned by the Issuer or any Restricted Subsidiary, as the case may be, the portion of the Satellite it owns or for which it has risk of loss), insurance (subject to a right of co-insurance in an amount up to $150.0 million) or other contractual arrangement providing for coverage against the risk of loss of or damage to such Satellite (or portion, as applicable) attaching upon the expiration of the launch insurance therefor (or, if launch insurance is not procured, upon the initial completion of in-orbit testing) and attaching, during the commercial in-orbit service of such Satellite (or portion, as applicable), upon the expiration of the immediately preceding corresponding policy or other contractual arrangement, as the case may be, subject to the terms and conditions set forth in this Indenture.

  • FHA Insurance The contractual obligation of FHA respecting the insurance of an FHA Loan pursuant to the National Housing Act, as amended.

  • Medical malpractice insurance means insurance against legal liability incident to the practice and provision of a medical service other than the practice and provision of a dental service.

  • long-term insurance business means the business of providing or undertaking to provide policy benefits under long-term policies, but does not include -

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  • Blanket insurance policy means a group policy covering a defined class of

  • Liability Insurance means compulsory professional liability errors and omissions insurance required by a governing body;

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