Thank you for choosing Southern Roots Dental of Louisiana as your dental care provider. We believe that all of our patients deserve the best dental care we can provide. We also believe that everyone benefits when specific financial arrangements are agreed upon. Please understand that payment of your bill is considered as part of your treatment. The following is a statement of our Financial Policy that we require you read and sign prior to any treatment. All patients must complete our information and insurance forms before seeing a doctor.
Your insurance policy is a contract between you and your insurance company. We are not a party in that contract. In the event that we do accept assignment of benefits and your insurance company has not paid your account in full within 60 days, the balance may be transferred to your account. Please be aware that some, and perhaps all, of the services provided may be non-covered services and not considered reasonable and customary under the terms of your insurance policy. Our practice is committed to providing the best treatment for our patients and we charge what is usual and customary for our area. You are responsible for payment regardless of the insurance company’s arbitrary determination of usual and customary rates. Your complete insurance information must be presented at the time of services provided. Insurance claims cannot be backdated. Most benefits will be verified before your insurance company can be billed.
All insurance co-pays and deductibles must be paid at the time of service.
Accepted Insurances Include: Guardian, Always Care, Vantage, and Metlife
We accept the following forms of payment: Cash, Check, VISA, Master Card, and American Express. Payment plan: Southern Roots Dental has partnered with Care Credit, a patient financing company, to offer our patients 0% interest financing for 3,6, or 12 months with approval.
Payment for services is due at the time services are rendered unless prior arrangements have been made with the doctor or treatment coordinator.
If treatment involves fabrication by a dental laboratory (dentures, crown/bridge, etc.), a 50% deposit will be required at the time of the first impression. The remaining balance is due at the time the prosthesis is cemented or inserted.
The parent that accompanies the minor(s) to the appointment is responsible for any payment due. For unaccompanied minors, non-emergency treatment will not be performed unless charges have been authorized before the appointment time or previous arrangements have been made with the doctor or treatment coordinator.
Checks that are returned to our office from your financial institution are subject to a $20.00 returned check fee. This fee covers the processing fees that are charged to our office.
All accounts that have not paid the estimated portion of their bill at the time of service will incur a monthly 1.5% finance charge (that equals 18% per annum rate).
Any account that has not received a payment in 60 days will be handed over to a collection agency that will pursue the responsible party for reimbursement. This will negatively impact your credit history and limit the treatment you can receive at our office.
We would be happy to discuss our charges and how they relate to your particular situation. We also realize that temporary financial situations may affect timely payment of your account. If such problems do arise, we encourage you to contact us promptly for assistance in management of your account.
Thank you for understanding our Financial Policy. Please let us know if you have any questions or concerns.