PATIENT POLICIES AND PROCEDURES
Fees and Payments
All accounts are due in full on your visit day, including previous balances.
We accept Visa, Mastercard, Discover, American Express, Personal Checks, Bank Checks, Money Orders, and Cash.
We do not offer an in-house post-service payment plan. Post-service payment plans are available through 3rd Party Creditors, Care Credit or Retriever. Ask our receptionist for details prior to service.
Effective July 2011, accounts with balances greater than 30 days will be charged an annual interest rate of 18% and past due accounts will be charged a late fee of $20 each month that the account is past due.
Effective September 2011, accounts with balances 90 days or greater will be directed to a Collections Agency.
Cancelation fee is $50 for all appointments with less than 24-hour notice.
Duplication of records fee is $10.
Returned check fee is $15.
In the event of divorced or separated parents, the payment is expected from the parent who brings the child to the office. We do not deal with or try to collect any money from a parent with whom we’ve had no direct communication.
In the event of divorce or separation, it is the responsibility of the two individuals to settle the account amongst themselves. We will not deal with or try to collect money from a party other than the guarantor on the account. Our dental system does not allow us to split family members when the account has a balance. When the account is brought to zero, then the system will let us split the couple.
Services Requiring Pre-Payment
Crowns and dentures require a 50% deposit on the first visit.
Billing and Collections
Our dental system consists of a family file, which contains the address, contact numbers, insurance information, and other key data. If your insurance coverage is through a spouse, ex-spouse, or parent, who is not a patient, they must be listed in the family file for billing purposes. Each family member has a separate ledger but, for statement purposes, a guarantor for the family ledger is identified. The guarantor is the person to whom statements will be addressed to and who is ultimately responsible to us for the entire family ledger.
If an account has a balance, which insurance will not or has not paid, a statement will be sent to the guarantor for the family account.
Payment is expected within 15 days. Interest and late fees apply to accounts over 30 days.
A statement will be sent each month until a family account is brought to zero.
If you do not contact us to establish payment arrangements, accounts over 90 days will be directed to a collections agency.
If you believe a billing error has occurred, please send a written notice to James J. Ostromecky, D.D.S., 48 Pleasant Street, Spencer, MA 01562, Attention: Accounts Receivable. An audit of your account will occur within 30 days with written explanation of our findings within 45 days. If the billing error is for services provided greater than 1 year back, an audit of your account will occur within 60 days with a written explanation of our findings within 75 days.
Please remember that insurance coverage does not eliminate you, the patient/parent/guardian, from being responsible for payment for services and costs not covered.
- We will submit the claim for you.
- Your insurance company will send payment directly to us.
- You remain liable for any deductibles and patient portions per the explanation of benefits, which accompanies the insurance payment that we receive. Most insurance companies will send you a copy of the explanation of benefit for your records. They are often labeled, “This is not a bill” and will have a section that identifies patient responsibility.
We pride ourselves on the fact that we are willing to work with most insurances when many other dental practices only accept a few. We process claims to insurance carriers as a courtesy and we strive to do our very best within the constraints and limitations of your insurance company and your plan. We are simply unable to guarantee 100% accuracy, 100% of the time.
Changes to insurance information, inclusive of carrier, group ID, coverage effective date, etc. are the responsibility of the guarantor and patient/guardian. We highly recommend that you call our office as soon as you know of an insurance change so that we my update your file and obtain your plan coverage percentages for services. This will make the next appointment for you or your family member to require less time and allow us to estimate your responsibility with a greater degree of accuracy.
Failure to provide updates and documentation to this office will result in denial of claims by insurance carriers and if the date of service falls outside of the new carrier’s claim submission allowed time, our office fees will then be applied for date of service.
Estimates provided by this office are calculated based on known fee schedules as provided by insurance carriers and patient. Estimates are subject to change based on coverage changes, remaining benefits, patient eligibility at time of service, and determination of non-covered services by insurance carrier. We are unable to guarantee estimates and final patient portions are calculated upon receipt of the explanation of benefits from the carrier. The explanation of benefits clearly determines the patient portion for the date of service and we make adjustments based on charges posted on the date of service. Adjustments can either be a credit or a debit to your account.
Pre-determination of benefits is a claim form that we can electronically submit to your insurance before you receive a service. The insurance company will send us, and generally you as well, an estimate of benefits that they will pay for the service. Insurance companies do not guarantee payment based on a pre-determination and they include a disclaimer that it should not alter the care you receive. When we receive a pre-determination from your insurance, we make every effort, in consideration of many factors, to call you to follow-up.
Annual Benefit Maximums are a control factor extended by most insurance, which limits the total payments that insurance will pay for your services in a particular period. This does not prevent you from having services but the insurance will not pay after an annual benefit maximum is reached and, with most insurance, our office fees then apply. We encourage you to monitor the usage of your insurance dollars and keep informed. We are unable to guarantee that we will be able to tell you when you have reached your annual maximum. We often do not know this until we receive an explanation of benefits from your insurance company.
Patients are seen by appointment only and require a reservation. We request that you call in advance to secure a time for your appointment.
Children under the age of 18 must be accompanied by a legal parent/guardian to all appointments.
To prevent identity theft, we require a photo identification and insurance card when you check in for your appointment.
As a courtesy, we send reminder calls/texts/emails 2 weeks, and 2 days before your scheduled appointment.
*If you are unable to keep your appointment, please know we require atleast a 24-hour notice to cancel or reschedule to avoid any fees.
Because appointments are reserved, we need for patients to arrive on time so that we may stay on time for appointments that follow. We reserve the right reschedule patients who arrive more than 5 minutes late.
We take pride in the care that we provide and we believe that if a case requires additional time that the patient deserves that time. Occasionally, this may cause a delay in room availability for you. If this occurs, we ask for your patience as we would spend the additional time with you as well but we respect that you may have other commitments. You have the option to wait or to reschedule.
Emergency Care During Patient Hours
Patients should call the office by 8 am and be prepared to come at the time that we have available in our schedule. Due to the type of room required for certain services, we may be unable to accommodate a specific time that you would prefer. Flexibility on your part is essential to providing you with an emergency appointment.
Patients with advance reservations will be seen prior to urgent/emergent patients.
Emergency Care After Patient Hours
If you are in severe dental pain due to an accident, trauma, or infection, please call us and listen carefully to the options and directions. Our answering service will contact the on-call dentist and s/he will attempt to contact you.
Fridays, Saturdays, Sundays and Holidays
We are closed Fridays, Saturdays and Sundays, New Year’s Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Thanksgiving and the Friday after Thanksgiving, and Christmas Day. Emergency services are limited on these days.
With the exception of weekends, Holidays, and inclement weather, our office is open daily and we do not close the office for vacations. However, when the dentist in on vacation and when communication is possible, the dentist is advised of all emergency calls. In the event that a patient needs to be seen, we will refer you to our back up service, which is a Worcester-based practice.
If you are unable to keep your appointment, you must call within our telephone hours and we require 24 hours notice. This courtesy allows us to offer the reservation to another patient.
We strictly enforce our policy to charge a fee for Cancelations with less than 24 hours notice and to charge a fee for Not Showing for an Appointment.
Patients/Families that have a history of 3 or more cancelations or no show for appointments will not be granted premium appointment times.
In the event of inclement weather, we are usually here and waiting to see patients. Please do not assume that the office is closed. If you decide to not keep your appointment, please call the office as soon as possible so we may manage our staff schedules and limit the travel of our staff. If you simply do not show, then our fees for not showing will apply.
On occasion, for the safety of our staff and patients, we may delay opening, close early, or close the office for the entire day. In this event, we will attempt to contact you at the numbers that you have provided; we may do this on the eve of a bad storm. If the weather turns bad and you have not been contacted, then please call us.
Our standard is to provide Composite (white) fillings vs. Amalgam (silver) unless otherwise clinically indicated.
Please note that the cost for Composite (white) fillings is greater than that of an Amalgam (silver) filling. The cost increase is proportional to the number of surfaces on the applicable tooth. The cost increase varies by insurance carrier.
If you do not wish to have Composite (white) fillings and would prefer Amalgam (silver), please inform both the Dental Assistant and the Dentist.
Grounds for Discharge
Unfortunately, there are circumstances that arise in which we determine that our ability to continue to provide service is no longer feasible. When we make this determination, we will discharge a patient or an entire family. Grounds for discharge include but are not limited to:
- Abuse of any member of our staff. Abuse is considered but not limited to verbal, physical, sexual or emotional, whether in person, on the phone, or otherwise. We have a zero tolerance policy.
- Failure to pay balances within a reasonable period of time. We determine reasonable.
- Failure to consent to services and standards such as a Complete Oral Exam and Full Mouth X-Ray every 3 to 5 years, annual bitewings, prophylaxis exams (cleaning) as recommended, periodontal evaluation and charting every 1-2 years based on clinical need, periodontal maintenance as recommended, and x-rays as needed to provide a thorough evaluation.
- Cancelation of less than 24 hours or not showing for an initial appointment (Complete Oral Examination and X-rays) with the Dentist and/or Prophylaxis Cleaning, Gross Debridment, or Scaling/Root Planing with a Dental Hygienist.
- Excessive cancelations and not showing for appointments for individuals or families. Excessive is defined as 3 consecutive appointments, 3 in 1 year, or 6 in 2 or more years. If associated fees have been paid, we may extend some leniency.