What Is Your Payment Policy?
At Groovy Smiles Pediatric Dentistry, your copay is due on the day of service, and your account must be paid in full before we can schedule your next appointment.
In consideration for services rendered by Groovy Smiles Pediatric Dentistry and practitioners employed by Groovy Smiles Pediatric Dentistry, I guarantee prompt payment of all such services not paid by insurance carriers or third parties within thirty (30) days. I understand that any amount not covered by my insurance carrier or other third-party payer is my personal responsibility, and I agree to make payments for any such amount. If Groovy Smiles Pediatric Dentistry does not receive such payment within thirty (30) days from the date such balance is due, the bill may be turned over to an attorney or a collection agency and, if so, I agree to pay all reasonable collection cost including attorney’s fees and/or collection fees in addition to the payment owed. I give Groovy Smiles Pediatric Dentistry the right to examine my consumer credit report for financial information related to my responsibility to pay for medical services.
Should your account be sent to a collection agency you agree, in order for “Mid-South Adjustment” to service your account or to collect any amounts you may owe us, Mid-South Adjustment may call the telephone number associated with your account. This includes wireless telephone numbers, which could result in charges to you. Mid-South Adjustment may also communicate with you by sending you text messages or e-mails to your wireless number or e-mail address. Methods of contact may include using prerecorded/artificial voice and/or the use of an automated dialing device. These authorizations shall remain in effect until individually withdrawn by you in writing to Mid-South Adjustment and/or any others to which authorization has been extended. I have read this disclosure and agree that Groovy Smiles Pediatric Dentistry may contact me as described above.
What Credit Cards Do You Accept?
We gladly accept payment via Visa, MasterCard, and American Express.
What Insurances Do You Accept?
- Anthem Blue Cross Blue Shield
- Arkids (Medicaid, Delta Dental Smiles & MCNA)
- Blue Cross Blue Shield (Any State)
- Cigna (PPO & DHMO)
- Connection Dental
- Delta Dental (PPO/Premiere)
- Dent Max
- Federal Blue Cross Blue Shield
- FEP Blue Dental
- Humana (Except Federal Humana)
- Lincoln Financial
- Municipal Health Benefit Fund
- Principal Financial
- Tricare (United Concordia)
- United Healthcare
Note that this list is subject to change. Call our office any time to confirm before beginning treatment. If you don’t see your insurance listed let us know! We want to make sure that we can meet your needs.