If you have insurance, we will Office Policies file your claims for you as a service In an effort to avoid to you. It is important that you Welcome misunderstandings, it is the provide us with current, accurate For most of you, the reason practice of this office to inform information. You must realize, you are here is because someone patients of our policies regarding however, that your insurance is a suggested that you see us. This financial arrangements and contract between you and the may have been your general appointments. insurance company. Payment to dentist, a friend, or a relative who If you have any questions us is your responsibility. If, at the is concerned about conditions in regarding any of these policies, end of the thirty working days, your your mouth that, if untreated, please feel free to ask. We want insurance company hasn’t remitted would lead to bone deterioration you to feel comfortable dealing payment to us, payment will be and tooth loss. We are here to with these matters. We are due in full from you. Please keep help you keep your teeth at their available to address any questions in mind that not all services are a optimum health, function, and or concerns. covered benefit in all contracts and aesthetics throughout your lifetime. Financial Policies are the patient’s responsibility. We will also do our best to make Payment is expected at the time Each time you are seen for an sure your visits here are services are rendered. To assist office visit or regular maintenance, comfortable and pleasant. you, we accept cash, check, VISA we ask that you pay us directly and and MasterCard. have the insurance benefits paid to Your First Visit For services over $200, you you. By following this policy, we As a new patient, we need to may pay one-third of the total fee keep our billing costs down and make ourselves familiar with your for each procedure upon our fees at a reasonable level. For individual needs. At your first visit completion of that procedure. The large dollar amounts we will accept we will get acquainted with your balance can be divided into three assignment of benefits from your past dental and medical history (3) equal payments, due each insurance carrier. and do a thorough examination of month for the following three A finance charge of 18% APR your teeth, mouth and gums. months. will be assessed on unpaid Using the diagnostic information, OUR FIRST CONCERN is your balances which are 90 days past we will consult with you on your dental health. We expect your due. specific treatment needs and critical dental needs to be met We realize that temporary answer any questions you may regardless of your financial financial problems may affect have concerning the time your situation. Therefore, other timely payment of your account. If treatment will take, what the payment options can be made such problems do arise, we recommended procedures involve, available, and will be discussed at encourage you to contact us and what it will cost. your first visit at your request. promptly for assistance in the management of your account. We Our Location do use outside agencies as a means of collection should we deem it necessary. N Holdrege St. Appointments Your scheduled appointment Dudley St. has been reserved especially for you. Any change in that time Orchard St. affects a number of people. Please keep in mind that changing appointments may result in delay Vine St. of treatment. We endeavor to reschedule you promptly as openings in our schedule will allow.

If you are unable to keep an Gateway appointment, please give us no Shopping Center O St. . d v

. Catherine S. Alley, D.D.S., M.S.

less than 24 hours notice. l t . . t B S t

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Missed or late broken e h t h 0 t n 6 7 t 6 6 o appointments may be charged a 5 minimum of $45.00. C Specialist in Periodontics Thank You Our ultimate goal is the preservation of your natural dentition and its supporting 1217 N. Cotner Blvd. structures in a healthy state. We Lincoln, NE 68505 attempt to treat our patients as we Catherine S. Alley, D.D.S., M.S. would like to be treated: gently, Specialist in Periodontics efficiently, and enthusiastically. (402)466-6700 We look forward to working with 1217 N. Cotner Blvd. [email protected] you. Lincoln, NE 68505

(402)466-6700