Thank you for choosing Lakeville Dental Associates as your dental healthcare provider. We are committed to providing you with the highest quality comprehensive dental care, so that you may attain optimum oral health. The following is our financial agreement which outlines your financial obligation to our practice. We require that you read, agree to, and sign prior to any treatment.

Payment is due at the time service is provided. Our office accepts cash, personal checks, credit cards and third party patient financing upon approval.

Dental Benefits:
  • We are an unrestricted provider and can accept any insurance plan that allows you to choose your own dental provider. We are not contracted or in network with any insurance carrier.
  • If you have provided us with your dental insurance information, we will file your claim as a complimentary service for you. We will always work to help you maximize your benefits based on the information provided to us by your insurance company. Please know that the treatment our doctors recommend will be based on your individual needs, not your insurance coverage.
  • We are happy to provide you with an estimate of what your dental benefits may cover for recommended treatment. This estimate is based on information provided to us by your insurance company. This is not a guarantee of what will be covered by your insurance company. Your insurance company and plan benefits will ultimately determine coverage and the amount paid.
  • We are happy to accept Assignment of Benefits whenever your benefit plan allows. Assignment of benefits is plan specific and between you, your employer and your insurance company.
  • If your plan allows assignment of benefits, Your deductible and co-payment, which is the estimated amount not covered by your benefit plan, are due on the day service is provided.
  • If your plan does not allow assignment of benefits, you are responsible for payment in full at the time service is provided. We will file the claim as a courtesy and your insurance company will reimburse you directly based on your dental benefit plan. We must emphasize that as your dental healthcare provider, our relationship is with you, our patient, not with your insurance carrier. Your insurance policy is a contract between you, your employer, and your insurance company. We will cooperate fully with any requests of your insurance company that may assist in the claim being paid. However, if your insurance company has not made payment within 60 days, you will be responsible for paying the full amount at that time. Our office will not enter into a dispute with your insurance company over any claim.
  • We are happy to help you review your dental benefits and answer any questions you may have, however, you are responsible for understanding your dental benefits.
  • You have ultimate financial responsibility for your account regardless of whether your insurance covers your treatment.

Over 60 days old will be subject to a monthly interest of 0.5% (APR 6%). If necessary, unpaid accounts will be transferred to a collection agency.