You must provide our office with a dental insurance card not medical with the proper mailing address and phone number of the insurance company. If this is not available at time of appointment, you will be responsible for payment . Benefits are not determined by our office. Your insurance benefits are a contract between you and your employer. The amount of coverage you will receive will depend on the quality of the plan purchased by your employer, Not the fees of the doctor. No insurance covers 100% If insurance benefits are assigned to the doctor, you will be responsible for paying your deductible and co-payments at the time of service. You are responsible for paying all charges not covered by your insurance company The office can not carry balances longer than 90 days regardless of insurance payment. A $5.00 monthly e-billing will be charged to your account if it is not paid within 90 days, regardless of balance. There will be a $25.00 service charge for all returned checks Parent or guardian who brings the child for their initial visit is responsible for payment independent of what a divorce doctrine may state. Reimbursement must be made between divorced parents. We will not intervene.