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Our Financial Policy

Thank you for choosing us to care for your child. Please read carefully our Financial Policy. Our main concern is to provide your child with the best possible care to establish and maintain oral health. Therefore, if you have any concerns about our payment policies, please do not hesitate to speak with our business staff. We ask that all parents read and sign our Financial Policy as well as complete our Patient Information Form prior to seeing the doctor.

Please be aware that the parent bringing the child to our office is legally responsible for payment of all charges. We cannot send statements to other persons.

Payment Options: Payment for care is due at the time services are rendered. We accept cash, check and for your convenience MasterCard and Visa. We offer a convenient patient financing program called CareCredit. This program enables families to finance their children's treatment interest free for three or six months. Please ask our business staff for information and an application.

Assignment of Insurance Benefits: If you would like for us to accept assignment directly from your insurance company on your behalf, you will need to agree to the following terms:
  1. Your insurance policy is a contract between you, your employer and the insurance company. We are NOT a party to that contract. Our relationship is with you, not your insurance company.
  2. All charges are your responsibility whether your insurance company pays or not. Not all services are a covered benefit in all contracts. Some insurance companies arbitrarily select certain services they will not cover. Fees for these services, along with unpaid deductibles and co-payments are due at the time of treatment. We will estimate your co-payments as closely as possible based on the insurance information you provide. [Continue]
  3. We will require a current credit card on file and a current Release and Assignment Authorization. Please be assured that your information will be maintained with the utmost confidentiality.
  4. When we receive a payment from your insurance company, we will bill the balance of the charges for that date to your credit card. If there is a valid family credit on the account, we will issue a refund. As a courtesy, we will call you regarding charges to your credit card account.
  5. If your insurance company, either primary or secondary, does not pay your balance in full within 30 days, we ask that you contact the insurance carrier to help speed things along.
  6. If we do not receive payment from your insurance company, primary and secondary if applicable, within 45 days of the date of service, the entire fee for that date of service will be charged to your account.
  7. If you do not wish to keep your credit card information on file with us, we will then require full payment at the time of service, and we will have your insurance company reimburse you directly.