woman entering information from a card while a man waitsPayment Responsibilities

An ADULT patient (18 years and older) is responsible for his or her own account.

The parent or guardian accompanying a MINOR (under 18 years) is responsible for that account.


Cash Accounts

Payment is due at the time of service.

Insurance Accounts

As a courtesy, our office will submit your insurance claim on your behalf and track claims.  Therefore, it is essential that we have complete and accurate information about your insurance company. Please keep us informed of any changes to your insurance plan. Most insurance companies should respond to the claim within four to six weeks.

We have found that patients who are involved with their claims process are more successful at receiving prompt and accurate payment services from their insurance carrier. We do expect patients to be interactive and responsible for communicating with your insurance carrier on any open claims.

Please remember that your insurance policy is an agreement between you and the insurance company.  No insurance company attempts to cover all medical costs.  Some have fixed allowances; others pay a percentage of the charge. It is your responsibility to pay any balance not paid or covered by your insurance.

While your insurance claim is pending, we will send you a monthly statement. Most insurance companies will respond within 4 – 6 weeks. Please call our office if your statement does not reflect payments made by your insurance company during that time period. Any remaining balance after your insurance has paid its portion is your responsibility and is due within 60 days.

Please be aware that accounts less than $350.00 must be paid at the time of service.  Accounts more than $350.00 will require that a percentage of the bill be paid at the time of service.  This percentage is based on an estimate of your deductible and coverage.  There may be a balance and this is your responsibility. Therefore, full payment or insurance balance is due at the time of service, depending upon your policy and type of insurance coverage.

Insurance pre-authorization (also know as pre-determination) for consultations and minor procedures may require rescheduling your appointment.  Sometimes a waiver must be signed making you responsible for the payment.

Be aware that some oral surgery procedures and I.V. anesthesia may not be covered under your particular dental insurance or medical insurance.

We are not MEDICARE providers and do not accept MEDICARE. Please understand that MEDICARE does not cover routine dental procedures or extractions, jaw preparation for partial dentures or full dentures, or dental related pathology.

We accept MEDICAID on a limited basis. Please contact our office for more information.


1. What is In-Network Dental Insurance? 

We are in-network providers for Delta Dental. What this means is that our practice and Delta Dental have agreed to a reduced fee schedule for our procedures. You will not be charged or responsible for the difference in our standard fee and the fee that we have agreed to accept from Delta Dental. We will also file your claim to Delta Dental and track the claim.

There are many variations and plans available under Delta Dental. Some may have maximum limits for coverage or may have non-covered procedures. As a courtesy, we can submit for pre-determination, which takes about 4 – 6 weeks.

2. What is Out-Of-Network Dental Insurance?

An out-of-network oral surgery provider does not agree to accept the fee schedule set by an insurance company. We are considered an out-of-network provider for all dental insurance plans, PPO, or HMO/DMO programs, except for Delta Dental. But you are certainly allowed to receive treatment in our office. Being an out-of-network provider simply means that we do not accept their fee reductions; we charge our standard fees.

As a courtesy, before you receive any treatment we can submit a pre-determination to your insurance company. This will establish what they will cover or “pay”, and takes about 4 – 6 weeks. You will be responsible for the balance that they do not pay.

We can also file your claim to the insurance company after your procedure has been completed. This will help you receive the maximum allowable benefits under your policy. Many plans have maximum limits for coverage or may have non-covered procedures. Therefore, frequently the balance that you may “owe” is not always very different from treatment with an in-network provider.

Usual and Customary Rates

We are committed to providing the best treatment for our patients.  We charge what is usual and customary for this area.  This fee is not based on insurance company’s determination of usual and customary rates.

Collection Process

Our billing office will help you with any questions that you may have.  You may contact them between 8AM and 4PM at Rocky Mount Office Phone Number 252-443-7331.  Any outstanding patient balance with no payment or activity within 60 days may result in your account being turned over to a collection service.  You will receive a monthly statement noting any insurance / patient balances and payments made within the last 30 days.  Please review the statement for accuracy and contact your insurance company regarding any outstanding claims.

Missed Appointments

Cancellations are acceptable if our office is notified at least 24 hours in advance.  Otherwise additional appointments may be denied.  Please help us to serve you better by keeping scheduled appointments.

Please note: Payment or Insurance Balance is due at the time of service.