We will be more than happy to file and track your dental insurance claims on your behalf as a courtesy; however, the guarantor of the patient account is responsible for the cost of the dental treatment.

    The ultimate responsibility of knowing your plan lies between you, your employer, and your contracted insurance carrier. Due to the vast number of insurance carriers, varied plans and changing agreements, it would be impossible for our office to be expertly versed in all plans, at all times.

    Please be aware that we can’t guarantee your carrier’s payment. It is up to you to know your policy benefits and limitations. The total treatment cost provided from Star Care Dental is an estimate based on the information we have on file for your specific insurance plan.

    If you have dual coverage dental insurance, this doesn’t always mean that you will receive dual payment. Some carriers have a non-duplication clause. If your company reimburses for a treatment, the secondary company may not. Please be aware of your policies.

    If you change insurance carriers during treatment, you must notify our office immediately. This could change the original contract and adjustments may need to be made.

    I have read and understand the above written insurance filing policy of Star Care Dental. I understand that any monies not paid by my insurance carrier, for any reason, shall be the responsibility of the guarantor.

  • By clicking submit, I agree that this signature is the electronic representative of my personal signature for use on all documents including legally binding documents in this office – in just the same way as a pen-and-paper signature.
  • Signed on: 09/23/2020