Financial Information

FINANCIAL POLICY

Thank you for choosing Daniel Quon, D.M.D as your healthcare provider. We are committed to providing you with the best possible care. The following is our Financial Policy, which we require that you read and sign prior to any treatment. Please understand that our Financial Policy is enforced to keep costs at a reasonable level, and to prevent frequent fee increases. This allows our office to provide you with the best possible care.

Full payment is due at the time services are to be provided. Accepted forms of payment include cash, all major credit cards and approved checks. Interest free financing is available with credit approval for services provided through CareCredit.

Insurance: While we are considered an out-of- network provider for all insurance companies, we make every effort to provide you with the most accurate quote and file your claims in a timely manner. We may accept assignment of insurance benefits. Deductibles and co-payments are to be paid at the time services are to be provided. The balance is your responsibility until your account is paid in full. Your insurance policy is a contract between you and your insurance company. We are not a party to that contract nor are we responsible for procedures that are not covered for any reason. We require complete and up-to- date insurance information to bill your insurance company on your behalf. If your insurance company has not paid their portion within 60 days, the balance will be billed to you.

Billing Charges: A $5.00 monthly billing charge will be applied to any account which has a balance 45 days past due.

Returned Checks: If a check is returned unpaid, there will be a $30.00 charge, and checks will no longer be accepted.

Collection Fees: Accounts that remain unpaid after 45 days will be turned over for internal collections to attempt resolution. When an account becomes 90 days past due, collection action may be taken outside of Daniel Quon, D.M.D. In this event, you will be responsible for all collection and legal fees.

Missed Appointments: We have a strict no call/no show policy. We ask that you provide notice 48 hours in advance to make changes and/or to cancel your scheduled appointment. While we understand that emergencies arise, we will do everything we can to accommodate your schedule. Unless cancelled at least 24 hours in advance, there will be a $50.00 charge for broken appointments which will not be covered by insurance. Due to the large block of time required for surgery and supplies, we require at least 24 hours’ notice for cancellations of your surgery. Failure to provide proper cancellation notice of your surgery appointment may result in additional fees up to 20% of the total surgical fee which is not covered by insurance. Repeated events may result in dismissal from the practice.