Stokes Dental Care

 Financial Policy

We are committed to providing you with the best possible care. To help us maintain billing costs to a minimum, we offer the following financial policy. Please understand that payment of your bill is considered a part of your treatment. We require that you read and sign the following financial policy prior to any treatment. If you have any questions, please do not hesitate to ask us. 

• We accept cash, checks, MASTERCARD/VISA/DISCOVER.
• An appointment, cancelled less than 24 hours or a broken appointment will be charged at a rate of a normal office visit. Please help us serve you better by keeping your scheduled appointments. 

• Returned checks will be subject to additional collection fees and charges.

• Minor patients: The adult accompanying a minor and the parents (or guardians of the minor) are responsible for payment.

• Patient and insurance billing are processed by First Pacific Corporation (FPC), a billing company dedicated to serving our patients.

PAYMENT IS DUE AT THE TIME OF SERVICE.  

Patients with dental insurance: We will continue to submit your insurance company. However, we ask that you pay your insurance co-payment at the time of service.  

• Preventative services – Co-payment is contingent upon individual policies of your plan. Typical co-payment requirement: 0%-20% of our fees.
• Basic services -- Co-payment is contingent upon individual policies of your plan. Typical co-payment requirement: 20%-30% of our fees.
• Major services – Co-payment is contingent upon individual policies of your plan. Typical co-payment requirement: 50%-60% of our fees.

  Note: Any insurance plan that pays directly to the patient, requires payment in full at the time of service, unless prior financial arrangements have been made.

• Senior Citizens (over 62 years of age): A 10% discount will be applied to your payment portion.
• Prepay discount: A 5% discount will be applied for prepayment of your payment portion in excess of $200.00

SPECIAL INFORMATION FOR PATIENTS WITH INSURANCE: 

• We will gladly discuss any questions relating to your insurance. However, please realize that:
• Your insurance is a contract between you, your employer and the insurance company. We are not a party to that contract.
• Our fees are generally considered to fall within the acceptable range by most companies, and, therefore, are covered up to the maximum allowance determined by each carrier. This applies only to companies who pay a percentage (such as 80%) of UCR. UCR is defined as usual, customary and reasonable fees for this reason. Thus our fees are considered UCR by most companies, unless, your insurance company reimburses based on an arbitrary schedule of fees, which bears no relationship to the current standard and cost of care in this area.
• Not all services are a covered benefit in all contracts. Some insurance companies arbitrarily select certain services they will not cover.
• As dental care providers, our relationship is with YOU, not your insurance company. While filing of insurance claims is a courtesy that we extend to our patients, all rendered charges are your responsibility from the date of services.

YOUR BILLING RIGHTS UNDER THE FAIR CREDIT BILLING ACT:

Late Charge: If your minimum payment is not received by the due date, you may be assessed a late payment charge. The amount of the late charge to be assessed is that maximum amount authorized under the State of CA laws. The late charge will be $5.00 or 5% of the past due minimum payment, whichever is greater, with a maximum of $20.00.

Finance Charge: A finance charge is imposed of those charges not paid in full within 60/90/120 days of the date you were first billed for the charges. The balance on which any finance charge is computed is determined by totaling the charges not paid within the required time period. The finance charge is at a periodic rate of 1.25 percent per month (an ANNUAL PERCENTAGE RATE OF 15 PERCENT). The finance charge is computed by multiplying the balance on which the finance charge is computed by the periodic rate shown above. There is a $0.50 minimum finance charge. 

Notify FPC in Case of Errors or Questions About Your Bill: If you think your bill is wrong, or if you need more information about the transaction on your bill, write to our billing company, First Pacific Corporation (FPC), PO Box 3000, Salem, OR 97302. FPC must hear from you no later than 60 days after they have sent you the first bill on which the error or problem appeared. You may telephone FPC but doing so will not preserve your rights.  

In your letter, please provide the following information:  

• Your name and account number
• The dollar amount of the suspected error
• Describe the error and explain, if you can, why you believe there is an error. If you need more information, describe the item you are not sure about.

Your Rights and First Pacific Corporation’s Responsibilities After Receiving Your Written Notice: 

• FPC must acknowledge your letter within 30 days, unless they have corrected the error by then. Within 90 days, FPC must either correct or explain why FPC believes the bill was correct. 

• After FPC receives your letter, FPC can not try to collect any amount you question, or report you as delinquent, FPC can continue to bill you for the amount you question, including finance charges and FPC can apply any unpaid amount against your credit limit. You do not have to pay any questioned amount while FPC is investigating, but you are still obligated to pay the parts of your bill that are not in question.

• If FPC finds that they have made a mistake on your bill, you will not have to pay any finance charges related to any questioned amount. If FPC did not make a mistake, you may have to pay finance charges, and you will have to make up any missed payments on the questioned amount. In either case, FPC will send you a statement or the amount you owe and the date that it is due. 

• If you fail to pay the amount that FPC thinks you owe, FPC may report you as delinquent. However, if their explanation does not satisfy you and you write to them within 10 days telling them that you still refuse to pay, FPC must tell anyone FPC reports that you have a question about your bill. FPC must tell you the name of the agency that they reported you to. When the matter is settled between you and FPC, FPC must also notify the agency that the matter is settled. 

• If FPC does not follow these rules, FPC can not collect the first $50.00 of the questioned amount even if your bill was correct.

Cancellation & No-Show Policy

Cancellations and no-shows are taken seriously at our office because it can make the difference between whether you succeed in your dental treatment or not.

Please understand that…

We require 24 hours notice in the event of a cancellation. Our answering machine is always on to take your important message. Even if it is a last minute cancellation, we greatly appreciate you notifying us so that we can schedule our waiting list patients into your space.

There is a $50 charge for a cancellation without proper notice. This charge will not be covered by insurance, but will have to be paid by you personally.

 When a patient does not show as scheduled, three people are hurt:

• The patient because they do not get the treatment they need as recommended by the doctor.
•  The doctor who now has a space in the schedule since the time was reserved for the patient personally.
• Another patient who could have been scheduled for treatment if there had been proper notice.

We appreciate your understanding. If you have any questions, please do not hesitate to ask us.