Office Policies
MELGOSA DENTAL FINANCIAL AGREEMENT
Thank you for choosing us as your dental care provider. We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our financial policy, which we require you to read and sign prior to any treatment.
GENERAL:
Please understand that regardless of any insurance status, you are responsible for the balance due on your account. You are responsible for any and all professional services rendered. This includes, but is not limited to, dental fees, surgical procedures, tests, office procedures, medications, and any other services not directly provided by the dentist.
MISSED APPOINTMENTS:
Unless we receive notice of cancellation 24 hours in advance, you will be charged an hourly rate for your appointment. Because our office is closed on Fridays, this does not count as a business day for the purpose of this contract. Please help us serve you better by keeping scheduled appointments.
Patients who show up 10+ minutes late to their scheduled appointment may be subject to a late arrival fee and/or may not be able to complete all scheduled treatment.
You will be charged an hourly rate of $75 for hygiene appointments and $200 per hour for treatment appointments with Dr. Melgosa.
INSURANCE:
Please remember that your insurance policy is a contract between you and your insurance company. We are not a party to that contract. As a courtesy to you, our office provides certain services, including pre-treatment estimates, which we send to the insurance company at your request. It is physically impossible for us to have knowledge and keep track of every aspect of your insurance. It is up to you to contact your insurance company and inquire about what benefits your employer has purchased for you. If you have any questions concerning the pre-treatment estimate and/or fees for service, it is your responsibility to have these answered prior to treatment to minimize confusion. Please be aware that some or perhaps all of the services provided may or may not be covered by your insurance policy. Any balance is your responsibility whether or not your insurance company pays any portion.
PAYMENT:
Full payment is due at the time of service. If insurance benefits apply, estimated patient co-payments and deductibles are due at the time of service unless other arrangements are made. If payment is delinquent, the patient will be responsible for payment of collection fees, attorney fees, and court costs associated with the recovery of the monies due on the account.
Office Hours: Mon-Thurs 8:00 AM - 5:00 PM, closed for lunch from 12:00 PM to 1:30 PM. Office is closed on Fridays.
Same-Day Appointment Cancellation Policy
Our appointment times are reserved specifically for each patient, and our team prepares in advance for your scheduled treatment.
If a patient arrives for a scheduled appointment and then chooses to cancel or leave for personal reasons unrelated to a medical or dental emergency, the appointment may be considered a same-day cancellation, and the applicable cancellation fee will be charged.
We appreciate your understanding and cooperation in respecting the time that has been reserved exclusively for your care.
DENTAL EMERGENCY
OUR OFFICE IS OPEN FOR DENTAL EMERGENCIES DURING OUR REGULAR BUSINESS HOURS.
A dental emergency is defined as uncontrolled bleeding, swelling, traumatic injury, or uncontrolled severe pain relating to the oral cavity.
In the event of a dental emergency, it is important to receive immediate attention. Here are several options to consider: Contact our office (209) 850-9229; Urgent Care; your local Emergency Room, or another dentist competent in emergency treatment. Dr. Victor Pak (oral surgeon) (209)667-5050 and Dr. Rupinderpal Singh (endodontist) (209) 427-0223 are my severe pain specialist. Please attempt to contact me first at the email below before reaching out to these specialist.
For severe bleeding bite down on gauze or apply firm pressure to the area until a professional is able to take over.
For severe swelling where the orbit or airway are affected, antibiotics are more than likely needed. Going to a local emergency room is highly recommended.
For severe pain (where OTC drugs aren’t sufficient), a prescription drug may be necessary. As of October 2, 2018, all licensed prescribers must use The Controlled Substance Utilization Review and Evaluation System (CURES), maintained by the Department of Justice (DOJ). It is a platform that tracks all Schedule II – IV controlled substances dispensed to patients in California. Once the patient’s information is submitted, a written prescription can be dispensed if deemed necessary by the doctor. Your general dentist, Urgent Care Facility, and Emergency Room can all assist with this.