Our Office Financial Policy


Carlo A. Ciaramitaro, DDS, PC
3308 Auburn Road, Auburn Hills, MI 48359
248-852-5222

It is customary for us to receive full payment at the time of service; patients with dental insurance are required to pay their estimated co-pays and deductibles at the time of service. When extensive treatment is planned requiring many appointments, we realize it may be necessary to make other arrangements. We have the following options available to you:

For Patients without Dental Insurance Coverage

For Patients with Dental Insurance Coverage

PLEASE BE AWARE: Insurance does NOT cover the entire fee of most services! The amount of coverage provided is decided between your employer and your insurance company and is out of our control. PLEASE NOTE: It is the patient's responsibility to know their insurance coverage and any changes that may occur.

We ask for payment of whatever percent the insurance does not cover of the cost for each service at the time it is rendered. We will complete and send whatever pre-treatment or estimation information that may be required, and we will send your insurance forms in for payment as each phase of treatment is performed. We will await the insurance check if they make payment within five (5) weeks. If payment from your insurance company is not paid within this time, you will be responsible for the balance owed and can await the insurance company payment.

Thank you for your cooperation.

Our Office Manager and Receptionist are responsible for scheduling your appointments and completing your financial arrangement. They will sincerely consider your needs in each of these areas. If you should have any questions regarding the above mentioned options, please do not hesitate to consult with them.

PLEASE NOTE: A Charge of $30.00 will be applied to your account for failed or cancelled appointments without a 48-hour notice.

Signature

Date