Fees
Our office’s overall fees are reflective of the quality of work we provide. Accordingly, Dr. Martz has elected to work with select laboratories whose fees may be slightly higher, but whose work is of the highest standard. Furthermore, Dr. Martz does not compromise on the quality of the staff she hires, the materials she uses, nor on the state-of-the-art sterilization techniques she employs.
If you have difficulty affording the fee associated with a particular procedure, please discuss this with our front desk manager to see what alternative payment plans may be arranged. Please note, this must be discussed and agreed upon before the procedures is completed.
Payment Policy
Patients who carry dental insurance should remember that their dental insurance is a contract between the patient and the insurance company. Insurance claims are submitted by this office as a courtesy to you.
Payment is due and expected at the time of service.
Patients are personally responsible for the amount charged for professional services rendered.
In the event your insurance company denies your claim, or only pays a portion of the claim, the patient is responsible for the balance.
Dental insurance companies, in some instances, require a deductible or a percentage of the cost of the procedure. That amount is due at the time of the procedure.
Office visits will be submitted to your insurance and their payments will be credited toward your total charges.
Because of the high demand for appointment time in our office, we require twenty-four (24) hour notification if an appointment can not be kept. If a twenty-four hour notice is not provided to our office, a broken appointment fee will be charged to your account.
NOTE: Not all office visits are covered by insurance. Therefore, the patient is also responsible for these uninsured amounts.
Forms
The three forms located below are our standard forms we require for each patient prior to seeing the patient for the first time. For new patients, in order to save yourself some time when you come in for your first appointment, please download, print, and fill out the
Patient Information & Medical History Form
Payment Policy Form
Notice of HIPAA Practices (You may just choose to read this on the screen, it does not need to be filled out. The Acknowledgment form below does, however, need to be filled out for each patient)
HIPAA Acknowledgement Form.