We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of your Dental Benefits that we require you read and sign prior to treatment.
We Gladly File Your Insurance
Your insurance policy is a contract betw,een you and your insurance company. It is important to know that professional services are rendered and charged to you, the patient.
It is our responsibility to provide the utmost quality care. Diagnosis and treatment are determined by your Doctor, not your Insurance Company. Our obligation is to help you as much as we can by completing all forms pertaining to your claim and submitting them promptly to your company. This helps you obtain the reimbursement you are entitled to receive as quickly as possible.
Because different Insurance Companies reimburse the office at their own “Usual and Customary Fee” rates (which may be lower than ours), there will be an In-Office Co-Pay for each visit of treatment to you, the patient. Should your total treatment be covered under your plan, our office will reimburse you, or add the credit to your account after the Insurance Coverage has been received.
As your doctor may be a “Provider” on your Particular Plan, this does not mean that each visit is covered at 100%. Not all dental services may be covered under your particular plan (ie Crowns, Gum Disease Treatment, and/or White Fillings). You may be obligated to pay the additional fee that your Insurance does not cover. At your request, we are willing to send a Pre-Determination to your Insurance Company before treatment so you have a greater understanding ofyour financial responsibilities.
Please Research your Insurance Company before your visit with us, so that we are able to serve you and answer any questions you may have. If there is a question about your Insurance Payment, or non-payment, we will be happy to assist you as much as we can, but the question and answers also should be directed to your particular Insurance Company. The more information the company receives, the greater chance the industry will change.
Thank You for understanding our Benefit Options. Please let our receptionist know if you have any questions or concerns.
I have read, understand, and agree to the provisions of these Benefit Options. In the event of defaults in the payment of arrangements made, and if these arrangements are placed in the hands of an attorney at law for collection, the undersigned hereby agrees to pay all costs of collection including a reasonable attorney’s fee. Presentment protest and notice are hereby waived.
Chelsea Hardesty, CDA
In 2012, Chelsea graduated from the Certified Dental Assistant Expanded Duties program at the Ultimate Medical Academy in Clearwater, FL. She enjoys making people happy through fixing their smiles. Chelsea loves spending time with her family, boating, and beaching in the Florida sunshine.
Chelsea is a 2012 Dental Assistant graduate with Expanded Functions from Central Florida Institute. Chelsea enjoys patient interactions, and making smiles better and brighter. She has 2 cats and enjoys beaching and reading.
Kara is a certified registered dental hygienist. Graduating from St. Pete College in 2013, she continued her education and completed her Bachelor’s degree in 2015 in Dental Hygiene. She enjoys dentistry because it is always changing and evolving. She helps our patients achieve optimal oral/overall health through preventative and gum tissue care. In her free time, she enjoys the beach and spending time with her friends and family.
Anjuli is originally from Chicago, and graduated in 2007 with her associates in Dental Hygiene from Hillsborough Community College. Continuing Education is a passion for Anjuli, and her appreciation for dentistry comes through the fact that it allows her to be a clinician and a lifelong student with the ever-changing technologies in medicine. She enjoys the culinary arts, fitness, cars, trivia, and travelling with her husband.
Kristy is a 2013 graduate of St Pete College’s Registered Dental Hygienist Program. As she was born and raised in Palm Harbor, she loves the area, work, and spending time with her family and friends. Kristy calms the nerves of anxious patients and enjoys educating for a healthier smile.
Born and raised in Florida, Shannon loves the sunshine, traveling, and spending time with her husband and 3 dogs. She has been in dentistry for over 10 years, and enjoys helping patients attain optimum health through scheduling planned treatment.
Adrianne has been in dentistry for over 10 years, and loves meeting new people. She helps our patients attain their dental health goals. Originally from Up State New York, Adrianne loves time spend with her family, reading, cleaning and traveling.
As Certified Dental Assistant, Shannon has had further education in TMJ Dysfunction. She enjoys helping patients understand how and why dental care is deemed necessary. Shannon likes nature walks, reading, and spending time with family and friends.