Patient Financial Policy

Brite Smile Family Dental Care · Marissa Z. Ramirez, DMD
1555 Webster St, Suite A, Fairfield, CA 94533 · (707) 421-8285

Thank you for choosing Brite Smile Family Dental Care. We want you to understand your treatment and its cost before care begins. Please read this policy, and ask us about anything that is unclear.

Payment at the Time of Service

• Your portion of the fee (including copays, deductibles, and any amount your insurance is not expected to cover) is due at the time of service.
• We accept cash, checks, and major credit and debit cards.
• If you have questions about your balance or need help planning payments for larger treatment, please talk with our front office before treatment begins.

Dental Insurance

• We are in network with Delta Dental, MetLife, Aetna, Anthem Blue Cross Blue Shield, Ameritas, and Guardian, and we work with most other PPO dental plans.
• As a courtesy, we will submit claims to your insurance company for you.
• Your dental insurance is a contract between you and your insurance company. Any estimate we give is based on the information your plan provides and is not a guarantee of payment.
• You are responsible for any amount your insurance does not pay, including deductibles, co-insurance, annual maximums, frequency limits, waiting periods, and services your plan does not cover.
• If your insurance company does not pay a claim within a reasonable time, we may ask you to pay the balance and follow up with your insurance company directly.
• Please bring your insurance card and a photo ID to your visits, and let us know right away if your insurance changes.

Treatment Estimates

• Before major treatment, we will review your treatment plan and give you a written cost estimate.
• If your treatment needs change, your cost may change. We will talk with you before making changes whenever possible.

Children and Minors

• The parent or guardian who brings a minor to their appointment is responsible for payment at the time of service.
• For children of separated or divorced parents, payment is the responsibility of the parent who brings the child to the visit. Any arrangement between parents is between the parents.

Cancellations and Missed Appointments

• If you need to cancel or reschedule, please call us at least 24 hours in advance so we can offer the time to another patient.

Account Balances

• We will send a statement for any balance remaining after insurance has paid.
• If you are having trouble paying a balance, please call us. We will do our best to work with you.
• Accounts that remain unpaid after reasonable notice may be referred to a collection agency.

Questions

If you have any questions about this policy or your account, please call our office at (707) 421-8285.

We will ask you to sign a copy of this policy at your first visit.