We are elated to have you with us! Please take the time to acquaint yourself with our office policies, and your financial obligations. Should you have any questions regarding this, we would be happy to answer them.

Appointment Confirmation

Our office will call, text and email 14 days, 7 days, and 24 hours prior to your appointment to remind you of your scheduled visit. We do this as a courtesy for our patients. A lack of reminder from our office does not indicate your appointment has been cancelled. If you believe you have an appointment with us, but have not received an advanced reminder, kindly contact us and we will be happy to confirm the date and time.

Cancellation Policy

If you are unable to keep your appointment time, it is your responsibility to notify our office 24 hours in advance to avoid cancellation charges. If a patient No Shows, Arrives Late, or Cancels their appointment without 24 hours notice a $50 fee for cleaning appointment and $100 fee for doctor appointment will be applied to the patient account. All cancellations must be reported via phone call or email. Cancellations left on the voicemail after business hours is not considered as a 24-hour notice.

We understand that sometimes unexpected situations and emergencies arise. We will work with you during such circumstances. Kindly keep in mind that this policy is in place to ensure each patient’s time, as well as our office time is valued and used efficiently to accommodate all of our patients.

Emergencies

When it comes to emergencies, it is our goal to get you scheduled as quickly as possible. We ask that you be flexible with your time which allows us to get you in the office more urgently. Emergency time is available during our regular office hours. Dr. Linty John-Varghese can be reached at 937-903-0835 after office hours to established patients only.

Copy of Records

We will gladly provide you with a copy of your dental records, and or X-ray’s. Under HIPPA and practice guidelines, patients must sign a records release form (that we can provide) indicating where the records need to be sent. Giving our office permission to send such records electronically. If you would like a hard copy of records, there will be a $25.00 fee. Please allow 2 to 5 business days for records to be sent.

Insurance

As a courtesy we will file all claims with your dental insurance. Patients that have Superior, Delta Dental or Anthem Federal plans will be required to pay for their appointments in full due to the Insurance Companies paying the patient. Payment will be due at the time of service.

Loyalty Program

This program is for patients who do NOT have dental insurance. Expires after 12 months, with options to renew after. It is the patient’s responsibility to schedule their treatment needs within the 12 months, to maximize benefits included in this program.

Scheduling Dental Appointments

All dental procedures longer than 90 minutes, will require a 50% deposit to reserve your appointment. Cancellations of these longer appointments in less than 24 hours will result in $100 cancellation fee. Our time is valuable, and it is difficult to fill these appointments at the last minute.

I have read the above information and understand the billing policy.

Insurance

As a courtesy we will gladly submit your dental claim for you. If an insurance company has not paid a claim a9er 30 days, the en=re balance is then the patient’s responsibility. Please understand your dental coverage, and we are always available for assistance with any ques=ons you may have. Your por7on of payment will be due at the 7me of service. In the event a claim is denied, it is not the responsibility of our office to appeal the claim. However, it is your right to call your insurance company and personally appeal the denied claim.

Past Due Accounts

An interest rate of 2% per month will be assessed to all Unpaid balances a9er 30 days of your statement. A balance for longer than 90 days will be subject to Collection Agency review. You will also be automatically dismissed from our practice. Any cost that arises from being in collections, or legal review will be the pa=ent responsibility. We encourage you to discuss all financial arrangements prior to your treatment to avoid unexpected statements. We will provide a courtesy call and email a9er 90 days to retrieve payment and resolve balance prior to any ac=on being taken.

Payment Methods

We accept Cash, Checks, Visa, MasterCard and Discover.

We do NOT accept American Express

Returned Checks

There will be a $35.00 Charge for returned checks by the bank.

• You may receive a billing statement by mail, text or email from Linty John Varghese D.D.S Inc. once a month if balance remains.
• Some insurance companies such as Anthem Federal, BCBS Federal, Delta Dental and Superior sends the check to you. Therefore, FULL payment will be required at the time of service. You may be re-imbursed for the portion that is allowed by your insurance company, as per your contract.

I have read the above information and understand the billing policy.