Office Financial Policy


Setzer, Cochran, Soares, & Hubbard Pediatric Dentistry

Barry P. Setzer, D.D.S. Stephen D. Cochran, D.M.D.
Flavio M. Soares, D.D.S. Karen A. Hubbard, D.D.S.

 

***AS A COURTESY, OUR OFFICE WILL BILL YOUR DENTAL INSURANCE COMPANY AS SOON AS YOUR COVERAGE IS VERIFIED BY OUR OFFICE.  WE ASK THAT YOU PROVIDE YOUR DENTAL COVERAGE PRIOR TO YOUR CHILD’S SCHEDULED APPTOINTMENT, TO ALLOW TIME FOR PRE-VERIFICATION. IT MUST BE FULLY UNDERSTOOD THAT THE CONTRACT FOR COVERAGE IS BETWEEN YOU AND YOUR DENTAL CARRIER AND YOU ARE FULLY RESPONSIBLE FOR ANY AMOUNT NOT PAID BY YOUR DENTAL INSURANCE COMPANY***

  1. As a courtesy, we will file your child’s dental claim(s) at time of service. Estimated copayments will be due at the time the services are rendered.
  2. Our office does NOT guarantee that your insurance will pay. We will make every attempt to receive verification of your policy and what it may cover. However, if for any reason the insurance claim is denied YOU are responsible for the full amount of the bill.
  3. Our office will NOT enter a dispute with your insurance company over any claim(s). This is your responsibility and obligation.
  4. Returned checks will be assessed a $35.00 processing fee.
  5. I authorize, Drs.Setzer , Cochran, Soares and Hubbard to release any information to my insurance carrier that they request.
  6. I authorize assignment of benefits on my behalf to Drs. Setzer, Cochran, Soares and Hubbard. I understand that assignment is NOT accepted as payment in full, I will be responsible for any balance.
  7. As the legal guardian, I accept responsibility for any payment due on behalf of my child. If payment for services cannot be made in full, a credit card will be required for any payment arrangements. If the legal guardian is unable to bring his/her child to the appointment, the payment arrangements must be made PRIOR to services being rendered. A “letter of consent to accompany a child” should also be provided.
  8. If you have any questions about the above information, or any uncertainty regarding your insurance coverage, please ask us. We are here to help you.

8355 Bayberry Road ▪ Jacksonville, Fl 32256 ▪ Phone (904)733-7254

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Setzer & Cochran https://setzerandcochran.com
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Document name: Office Financial Policy
Unique Document ID: febb13d3264ace9fb5ba82cc1721e25e26f21af4
Timestamp Audit
2016-10-26 15:11:16 EDTOffice Financial Policy Uploaded by Barry Setzer - awillson@setzerandcochran.com IP 50.73.244.114