Office Policies
Thank you for entrusting your dental care to us. To enhance communication and promote understanding of our policies, please review the following information. By providing your signature, you indicate that you have read, fully understand, and fully agree to our policies. This form must be signed to receive care in our practice.
Insurance: Our office is dedicated to helping you maximize your insurance benefits. We currently serve as “in-network” and “out-of-network” providers for several insurance plans. Because insurance policies vary greatly, we can only ESTIMATE your coverage in good faith and cannot guarantee coverage. If your insurance company pays less than the estimate or denies payment on your claim, you are responsible for the remaining balance. We do not file secondary dental or medical insurance claims.
Patient Payment: We are a zero-balance office. This means the estimated payment due for your dental care must be paid in advance, or on the day of your treatment. We accept cash, credit cards, debit cards, and local checks. We do not accept post-dated checks. We can also assist you in obtaining third-party financing through our partnerships with Sunbit or CareCredit.
Identification: For us to file insurance claims on your behalf, you MUST provide your driver’s license and possibly your social security number. We also require this information if you pay for your care using Sunbit or CareCredit. If you are not comfortable providing us with this information, we are happy to treat you; however, you will need to pay for your dental care in full and file your own insurance claim.
Mutual Respect: We have an amazing team at Hutto Premier Dentistry that treats every patient with respect, kindness, and grace. We expect the same in return. Any patient who belittles a team member, uses profanity toward them, or shouts at them will be asked to leave our premises and dismissed from our practice as a patient.
Communication: In addition to phone calls, we use email and automated text messaging to communicate with patients. You can opt out of text and email if you choose.
Account Ownership: Once a young adult patient is no longer covered under a parent or guardian’s insurance plan, we will create a dedicated account for them in our system.
Rebilling: A $25 rebilling fee will be assessed to your account if payment is not arranged by the end of the first billing cycle. After the second billing cycle in which payment on your account is not arranged, it may be turned over to a collections agency (a third party). In addition to the amount owed, you will also be responsible for additional legal fees associated with collecting your balance.
Accounts with a Balance: Accounts must be “current” and have no balance to receive treatment. For accounts with unpaid balances, future appointments on those accounts may be proactively canceled to ensure those times are available for patients with current accounts. Once you have paid your balance, we can then schedule you for future care.
Returned Check Fee: A $50 fee will be assessed on all returned checks. No future checks will be accepted as payment.
Broken Appointments: A specific time is reserved just for you with your doctor or hygienist. If you need to change your appointment, we require at least 48 hours’ notice to avoid a $50 cancellation fee, which may be assessed to your account. Multiple missed appointments will result in dismissal from our practice.
We welcome you to our family and look forward to helping you establish and maintain a healthy, beautiful smile. Thank you!
Insurance: Our office is dedicated to helping you maximize your insurance benefits. We currently serve as “in-network” and “out-of-network” providers for several insurance plans. Because insurance policies vary greatly, we can only ESTIMATE your coverage in good faith and cannot guarantee coverage. If your insurance company pays less than the estimate or denies payment on your claim, you are responsible for the remaining balance. We do not file secondary dental or medical insurance claims.
Patient Payment: We are a zero-balance office. This means the estimated payment due for your dental care must be paid in advance, or on the day of your treatment. We accept cash, credit cards, debit cards, and local checks. We do not accept post-dated checks. We can also assist you in obtaining third-party financing through our partnerships with Sunbit or CareCredit.
Identification: For us to file insurance claims on your behalf, you MUST provide your driver’s license and possibly your social security number. We also require this information if you pay for your care using Sunbit or CareCredit. If you are not comfortable providing us with this information, we are happy to treat you; however, you will need to pay for your dental care in full and file your own insurance claim.
Mutual Respect: We have an amazing team at Hutto Premier Dentistry that treats every patient with respect, kindness, and grace. We expect the same in return. Any patient who belittles a team member, uses profanity toward them, or shouts at them will be asked to leave our premises and dismissed from our practice as a patient.
Communication: In addition to phone calls, we use email and automated text messaging to communicate with patients. You can opt out of text and email if you choose.
Account Ownership: Once a young adult patient is no longer covered under a parent or guardian’s insurance plan, we will create a dedicated account for them in our system.
Rebilling: A $25 rebilling fee will be assessed to your account if payment is not arranged by the end of the first billing cycle. After the second billing cycle in which payment on your account is not arranged, it may be turned over to a collections agency (a third party). In addition to the amount owed, you will also be responsible for additional legal fees associated with collecting your balance.
Accounts with a Balance: Accounts must be “current” and have no balance to receive treatment. For accounts with unpaid balances, future appointments on those accounts may be proactively canceled to ensure those times are available for patients with current accounts. Once you have paid your balance, we can then schedule you for future care.
Returned Check Fee: A $50 fee will be assessed on all returned checks. No future checks will be accepted as payment.
Broken Appointments: A specific time is reserved just for you with your doctor or hygienist. If you need to change your appointment, we require at least 48 hours’ notice to avoid a $50 cancellation fee, which may be assessed to your account. Multiple missed appointments will result in dismissal from our practice.
We welcome you to our family and look forward to helping you establish and maintain a healthy, beautiful smile. Thank you!