CA Financial Policy
Thank you for choosing us as your dental care provider. We are committed to delivering the highest quality care in a transparent and respectful manner. Please review the following policy carefully.
Payment Policy:
- Full payment is due at the time services are rendered. Unless arrangements are made with a credit card on file for monthly installments.
- Acceptable payment methods:
- Credit Cards: Visa, MasterCard, American Express
- Debit Cards
- Cash or Personal Checks
- Returned Checks:
- A $25 fee will be assessed for the first returned check.
- A $35 fee may be charged for any subsequently returned check (CA Civil Code 1719).
Unpaid Balances and Interest:
- If your balance is unpaid 60 days after treatment, a service charge of 2% per month (24% APR) may apply in accordance with federal Truth in Lending requirements.
Insurance Information:
- Please note: We may be out-of-network with your dental plan. We are happy to submit claims as a courtesy, but you are ultimately responsible for any balance due after adjustments are made.
- Your dental insurance is a contract between you and your insurance company.
- You are financially responsible for all services provided by our office, regardless of insurance coverage or reimbursement.
- If your insurance has not paid within 60 days, the outstanding balance becomes your responsibility.
- Need help understanding your insurance benefits? Just ask, we are here to assist.
Minor Patients:
- The parent or legal guardian is financially responsible for treatment provided to a minor.
- If the party responsible is not present at the time of service, the credit card on file will be charged, as authorized in advance.
Medical Debt Reporting Compliance (SB 1061 – effective 7/1/25):
In compliance with CA SB 1061, we do not report medical debt to any consumer credit reporting agency:
A holder of this medical debt contract is prohibited by Section 1785.27 of the Civil Code from furnishing any information related to this debt to a consumer credit reporting agency. If such information is knowingly furnished, the debt shall be void and unenforceable.
Billing Disputes and Patient Rights:
We are committed to transparent billing. If you believe your bill contains an error or have any concerns, please contact our office within 30 days of receiving your statement. We will review and respond promptly to resolve any issues.
Language Assistance:
If you require this policy in another language, please notify our front desk. We are committed to serving the needs of our diverse patient community.
Acknowledgement and Agreement:
I have read, understand, and agree to the terms outlined in this financial policy. I accept responsibility for all charges incurred and authorize the office to process payments as specified above.
I understand that any legal action to collect unpaid balances will be based on this written and signed agreement, in compliance with California AB 1414.