Rena Bains DDS Inc

Periodontal & Implant Reconstruction 
Working Together Achieving Optimum Oral Health

Fees & Payment Options

Treatment

Your recommended treatment is based solely on our professional opinion.  Treatment recommendations are not based on your dental benefit plan because it is not in your best interest.  It is our daily goal to provide our patients with quality periodontal care.  Part of this commitment is being sure you understand our fees and our flexible payment options.


* Patients needing financial assistance can discuss the various options available with our Treatment Coordinator.

   
 

Lynda
Treatment Coordinator


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 Patients covered by dental benefit packages; e.g. insurance, are encouraged to provide complete and accurate information about their dental plan when they complete our Patient Information form. Failure to complete the section regarding insurance may result in a delay in processing your claim. We will ask for...
diamond.gif (133 bytes) Employer Name                                       
diamond.gif (133 bytes) Employee Date of Birth
diamond.gif (133 bytes) Employee Name                                       diamond.gif (133 bytes) Plan or Group Number
diamond.gif (133 bytes) Name, address & phone of Insurance co.

diamond.gif (133 bytes) Employee Identification Number which may be the Social Security Number            

small.gif (312 bytes)Please print out the following forms.
Instructions: Click on the link below and print from the screen. 

Health History Form

Responsible Party Form 

Notice of Privacy Practices


Please complete both forms in detail and bring them with you to the office.

 

 Zero Interest Loan Available

We can provide you with an application for a zero interest loan through Care Credit.  We also accept MasterCard, Visa, American Express and Discover credit cards. And, of course, checks and cash are always welcomed.

 

 Discounts Available

We offer cash discounts (5% for cash, checks, and credit card payments) on treatment exceeding $500.00 when paid    in full by the date of the treatment.  If you have a substantial co-payment, this can be a significant savings for you. If you have paid in full, in advance, then any payments we receive from your benefit provider will be promptly reimbursed to you.

 

Filing Insurance Claims

We are happy to file the necessary forms to insure that you receive benefits from your dental benefit provider. However, we can make no guarantee of any estimated coverage. Because the insurance policy is an agreement between you and your dental benefit provider, we ask that all patients be directly responsible for all charges.

Your Account

We strive to keep all of our patients informed.   This includes information as to the status of your account.  You will receive statements from our office as long as there is a balance on your account.  Toward the bottom of the statement, there will be information regarding what has been billed to your dental benefit provider.  The average insurance claim takes four to six weeks to be processed by your benefit provider.  Please contact your benefit provider if there are delays in the processing of your claims.  If charges remain unpaid after 90 days, administrative charges will start to incur.

 

Thank you for being our patient.
Please contact our staff if you have any questions.
(209) 578-4153