Our Office Visit Policies
Columbia Regional Center for TMJ and Orofacial Pain believes that part of good healthcare practice is to establish and communicate a clear financial policy to our patients. We are dedicated to providing the best possible care for you, and we want you to completely understand our financial policy. Please take time to carefully review the following information and return this form to the front desk with your signature and today’s date.
MISSED APPOINTMENTS/CANCELLATIONS: At Columbia Regional Center for TMJ and Orofacial Pain, our goal is to provide quality care in a timely manner. We have implemented a no show and cancellation policy which enables us to better utilize available appointments for our patients in need of care. The following policy is with regard to patients who fail to keep or arrive late to their scheduled office visit. When you schedule an appointment with Columbia Regional Center for TMJ and Orofacial Pain, we set aside enough time to provide you with the highest quality care. Please be courteous and call in advance if you are unable to attend an appointment. This time will be reallocated to someone who is in urgent need of treatment. Available appointments are in high demand and your early cancellation will give another person the possibility to have access to care. Current patients need to contact the office 24 hours in advance if they wish to cancel their appointment. Those who fail to show for their scheduled appointment or did not notify the office within 24 hours of their scheduled appointment time will incur a $99 fee to be paid prior to reschedule. This fee is the responsibility of the patient and is not covered by insurance. Those who arrive late will have their appointment time adjusted to end on time. New Patients that do not show to their appointment or do not give 48 hours’ notice may reschedule after placing down a scheduling deposit.
INSURANCE: We want to ensure that insurance and finances do not stand in the way of your treatment. Our focus is entirely on providing you with the best and most appropriate care. It has been our experience that most medical insurance companies are not supportive of TMJ or sleep apnea dentistry. We are out of network with most insurance companies. Full payment is due at time of service. We accept cash, personal check, all debit/credit cards, and CareCredit. We also provide an in-house, interest-free payment plan for treatments. As a courtesy, we will send your paperwork to your insurance company and ask them to reimburse you for monies spent in our office.
OUTSTANDING BALANCE: In the instance that you have an outstanding balance due to NSF check or failed payment, you will receive a statement notifying you of the amount due. We accept cash, personal checks, Credit/Debit cards, and CareCredit. A $30.00 fee plus any bank charges will be charged for any NSF/returned checks. You are ultimately responsible for the timely payment of your account. Balances that are not paid within 30 days of the first statement are subject to a 5% per month interest. Delinquent accounts will be required to pay fees prior to future service.
COLLECTION FEES: I understand that in the event my account is placed in collection status, any additional fees incurred due to this, will be added to my outstanding balance. This includes but is not limited to late fees, collections agency fees, court costs, interest and fines. I understand that these additional fees will be my personal responsibility to pay in full.