Thank you for choosing Keene Dentistry & Implants for your dental needs. In an effort to provide quality care to our patients and to avoid any misunderstandings, we would like to inform you of our office policy regarding payment for services rendered.
Payment is expected at the time treatment is performed. As a courtesy to our patients with dental benefits, we will submit your claim to your insurance company. Any portion not expected to be covered by these benefits is the responsibility of the patient and due at the time the service is rendered. This amount will include deductibles and estimated cost share
(co-payment) for treatment. If benefit amounts are less than expected, you will be billed for the difference and payment is due within 30 days.
Dental benefits are contracts between the policyholder and the insurance company, not our office. We will make every effort to assist you with any benefit questions, however we highly recommend that you be aware of what benefits you have available. Ultimately, you are responsible for any account balance. Please be advised that you may be asked to present a current identification so we may make a copy for your record. This is to help prevent identity theft and insurance fraud.
Marital status is not a consideration under any circumstance. Decreed custody or lack thereof, does not alter financial responsibility. The parent accompanying the child/minor on the day of service will be considered the responsible party. We will gladly provide you with copies of statements, which you may need to provide the other parent for reimbursement.
There is a $35.00 charge for returned checks. If a check is returned and not paid within 14 days of return date, legal action may be taken for collection. Any costs associated with collection of returned checks will be assumed by the patient.
In the event your account becomes delinquent, a late charge of 1.5% will be assessed each month. Failure to keep your account current may result in not being able to receive additional dental services except for emergencies and prepayment requirements for services. You will be responsible for collection fees, attorney fees and court costs. Delinquent accounts transferred to collection will be assessed a fee up to 40% of the unpaid balance.
We accept: Cash, Check, Visa, MasterCard, and Discover. We also offer payment plans for your convenience with CareCredit as well as Lending Club. Please ask our staff for details on different finance options.