Payment Policy


    To confirm your understanding and agreement with our policies, please read the following:

    Payment in full is due at the time services are rendered unless prior financial arrangements have been made. We accept Visa, MasterCard, Debit, and Cash.

    Insurance: Our office is committed to helping patients maximize their benefits. Insurance policies vary greatly. Therefore, owing to the complexity of Insurance contracts, you are fully responsible for knowing your own insurance plan and what you are not covered for. Treatment is recommended based on what you need NOT on what you are covered for. As a courtesy, we will gladly send your claim electronically for you, on your behalf, to your insurance company providing that your company does allow electronic submission.

    We wish to stress that the financial responsibility for services rendered rests with the patient and his/her family, regardless of any insurance coverage; your insurance policy is a contract between you and your insurance company. We cannot guarantee payment or coverage of your claim.

    I agree to pay all fees and charges for services rendered at Capital Periodontics for myself and my family. I agree to pay all charges when presented with a statement, unless prior credit arrangements are agreed upon in writing. I understand and agree, regardless of my insurance status, I am ultimately responsible for any unpaid balance on my account.



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