Disclaimer

Insurance Liability for Payment

Your dental insurance company will only pay for services that it determines to be “reasonable and necessary.” Every effort will be made by this office to have all services and procedures pre authorized by your dental insurance company, when applicable. If your dental insurance company determines that a particular service is not reasonable and necessary, or that a particular service is not covered under the plan, your insurer will deny payment for that service. We suggest to all patients that they contact their insurance to confirm that these services are covered.

Patient Responsibility

A quote of benefits and/or authorization does not guarantee payment or verify eligibility. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service. I understand that my dental insurance company may deny payment for the services due to the reasons stated above. If my dental insurance company denies payment, I agree to be personally responsible for making the full payment to Dental Solutions/Dr. Elias Pimentel. I also understand that if my health insurance company does make a payment for services, I will be responsible for any co-payment, deductible, or coinsurance that applies.