Walter D. Andrada, DDS 9330 Carmel Mountain Road, Suite B, San Diego, CA 92129 858.780.0819
Thank you for choosing our practice as your dental care provider. We are committed to your treatment being successful. The following is a statement of our Office Policy, which we require you to read and sign prior to treatment. All patients must complete our New Patient forms before seeing the doctor. FULL PAYMENT OF PATIENT’S COPAY IS DUE AT THE TIME OF SERVICE.
WE ACCEPT CASH, CHECKS, VISA, MASTERCARD, AND CITIFINANCIAL.
USUAL AND CUSTOMARY RATES
Our practice is committed to providing the best treatment for our patients and we charge what is usual and customary for our area. Patients are responsible for payment regardless of any insurance company’s arbitrary determination of usual and customary rates.
TREATMENT PLANS AND INSURANCE
Fees for treatment are estimates only, are valid for 20 days from the date treatment estimate is presented, and are subject to revision. Treatment could be altered if the patient’s dental needs change, which could also alter the fees. The patient will be notified of any change(s) in treatment. All ESTIMATED patient portion and deductibles are due at the time of treatment. After payment is received from the insurance company, any remaining balance will be the responsibility of the patient.
As a routine courtesy to our patients, we submit the charges to the insurance carrier on our patients’ behalf.
Insurance is a contract between the patient, the patient's employer and the insurance company. It is the patient's responsibility to understand their insurance benefits and limitations: not all services are covered by insurance. It is the patient's responsibility to notify our office of any changes in insurance coverage at the time of the appointments to ensure that claims are submitted to the correct insurance company.
By signing the consent on our New Patient forms, the patient acknowledges that our office has advised that, if payment is not received from the insurance company within 45 days of submission of the claim, the patient will be billed for the dental charges incurred.
At that point, we will provide the patient with an insurance claim form so that payment from the insurance carrier can be pursued by the patient.
The adult accompanying a minor is responsible for full payment. For unaccompanied minors, please make arrangements for payment to be made at the time of treatment.
If you are unable to keep your scheduled appointment, please give our office notice at least one business day in advanced. There is a minimum $50.00 charge for all missed appointments and all cancellations made the day of the appointment. Please help us serve all our patients better by keeping your scheduled appointments.
We reserve the right to charge interest in the amount of 18% per annum as provided by state law.