Patient Billing

For your convenience we accept Visa, MasterCard and Discover. We also offer patient financing through CareCredit. We deliver the finest care at the most reasonable cost to our patients, therefore payment is due at the time service is rendered. If you have questions regarding your account, please contact us at Burlington Office Phone Number 262-763-8360. Many times, a simple telephone call will clear any misunderstandings.

Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage.

We will send you a monthly statement. Most insurance companies will respond within four to six weeks. Please call our office if your statement does not reflect your insurance payment within that time frame. Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated. 

Financial Policy

Payment During Treatment: Cash, check, or credit card at the time of service. 

Outside Financing Option: As a service to our patients, we are pleased to offer CareCredit, the nation’s leading payment plan. CareCredit has several payment plans to meet every financing need, including interest free and low interest options. It is easy to apply and you will receive a decision in seconds.  To apply or receive more information, please visit with one of our case coordinators or proceed to the website for CareCredit

Insurance: As a courtesy we will file your insurance claim form for you if you  bring:                                 1. Your dental insurance card                                                                                                                                         2.  Provide all of your employer information.                                                                                                           If we are unable to verify your insurance information before treatment, you will be expected to choose from of the above payment options.  As you know, your insurance benefits are determined by your employer.  **Any deductible or estimated co-payment will be due at the time of treatment.**  Your insurance and payment for services rendered is still your responsibility.  If payment for previous services has not been paid in full within 45 days the remaining balance is considered due and payable. 

New Patient/Urgency Appointments: We will be happy to make an appointment for you to take care of your treatment needs.  For these specific types of appointments, payment will be collected in full at the time of service until you are established in our practice as a participating patient. Once established, the above payment policies will apply. 

Broken Appointments: Appointments are reserved with a dental professional.  Therefore, a phone call or letter will be extended to patients who do not show for their appointment. A broken appointment fee of $50.00 will be assessed for any appointment that is not cancelled 1 regular business day in advance.  If a second appointment is broken, a $100.00 nonrefundable reservation fee will be requested from you before we reappoint for future treatment. 

Short Notice Cancellation: We reserve the right to charge $50 broken appointment fee and collect fees for appointments that are cancelled or broken without 1 regular business day notice.  Appointments are reserved exclusively for you.  If cancelled or broken, the time is taken away from other patients who are waiting to be placed in our schedule. 

Returned Check Fee: $25.00 will be added to your account balance if a check is returned to us as Non-Sufficient Funds.  

Finance Charge: A service charge of 1.5% per month (18% per annum) on the unpaid balance will be charged on all accounts with a balance exceeding 60 days, unless previously written financial arrangements are agreed upon. 

Delinquent Accounts: We do reserve the right to utilize a collection agency if the guarantor does not adhere to the Financial Policy.  In the event this account is placed with an attorney or collection agency, the guarantor is responsible for collection fees (50% of unpaid balance), reasonable attorney’s fees, and court costs.