Please read carefully and sign to acknowledge understanding and agreement.
Thank you for choosing us as your dental care provider! We are committed to providing you with the best dental care
available. Below we have outlined several payment options to help you get the dental treatment you may need, want
and deserve.
Available Payment Options
You can choose from - Cash, Check, Visa, Mastercard, American Express
We offer a 5% prepayment bookkeeping courtesy for to patients who pay for their treatment in full, at the time of
scheduling. Financing is available, ask us for details.
Dental Insurance
For patients with dental insurance, we are happy to work with your carrier to maximize your benefit and directly
bill them for reimbursement on your behalf.
Your insurance is a contract between you and your insurance company. Stunning Smiles of Las Vegas is not part of
that contract.
Not all services are covered benefits in all contracts. Some insurance companies arbitrarily select services they
will and will not cover.
If your insurance carrier does not pay the estimated benefit in full, you will be immediately responsible for any
remaining balance. This balance may include any deductibles, co payments, denials and non covered services.
If we do not receive payment from your insurance carrier within 60 days, you will be responsible for payment of your
treatment fees to our office and collection of your benefits directly from your insurance carrier.
Dental Benefits/Insurance
We will attempt to verify your benefit plan and give you as close of an estimate as we can for your treatment.
Please understand that we don't know exactly how much your dental benefits will pay until the claim comes back. We
do our best to give you an accurate estimate.
We will try to answer any questions we can about your dental benefit plan and, when possible we will assist in
resolving any issues with claims. Please understand that we cannot speak on their behalf. Your insurance contract is
an agreement between you, your employer and your insurance carrier. In the event that your dental benefit company
has not paid for your treatment, you will be responsible to pay your account.
Scheduling
We do collect your estimated patient portion or in order to reserve time in Dr. Racanelli's schedule, or for an
appointment time with our hygienist longer than 1 hour (except for new patient appts.). This allows us to provide
the highest level of care to our patients. Should you have a residual balance after your insurance claim is closed,
we will reach out to you to let you know.
Collections on Balances due
A charge will be added to your account for any returned checks.
If you are experiencing financial difficulties in paying your balance, please reach out to use and we are happy to
work with you to bring your account current.
Should your account be sent to collections, you are responsible to pay all costs of collecting, or attempting to
collect any debt owed on this account. This includes all attorneys fees, interest, and late fees.
Responsible Party
As the responsible party, in the case where my spouse and/or children are also patients at Stunning Smiles of Las
Vegas, signing this Office & Financial Policies will apply to them and their accounts as well.