In order to keep our fees from increasing considerably and to minimize
the expense of billing and accounting, we have chosen to offer our
patients several financial options.
- Payment at time of treatment by cash, check or credit
- Prepayment of a selected treatment plan to receive a 5%
- In-office finance plans that offer 90-day to 12-month
interest free loans on approved credit. (Care Credit)
If you have dental insurance, we will accept assignment directly from
your primary insurance company if you agree to the following terms:
- I am responsible for the payment of all treatment fees on my
- I am responsible for the estimated portion not paid by the
insurance company at each visit. If the estimate of insurance benefits
indicates a large amount due by me and I feel I cannot pay it during
treatment, I can request a written financial agreement. (Terms to be
discussed at that time).
- If upon payment by the insurance company, there is a remaining
balance, I am responsible for the amount in full at that time.
- If my insurance company fails to make payment within 60 days, I
will be responsible for the amount in full at that time.
- For delinquent account, beyond 90 days, I agree that the office of
Dr. Grace Hsu reserves the right to pursue the full payment through
collection agency service at my own expense.
Please be aware that some of the services provided may not be covered
or may be reduced to an alternate benefit under your insurance plan.
For example, most insurance companies will reduce their benefit for
composite (white) fillings to the benefit for an amalgam (silver)
filling. This will result in a higher out of pocket expense, as our
office does not perform amalgam fillings.
Our office does not accept assignment from secondary insurance.
Usual and Customary Rates
Our practice is committed to providing the best treatment for our
patients. You are responsible for payment regardless of any insurance
company's arbitrary determination of usual and customary rates.
Minor Patients : The adult accompanying a minor or the parents/
guardians of the minor are responsible for full payment
Interest : It is the office policy to assign a late charge of 1 % per
month on any unpaid balance over 60 days.
Unless cancelled, at least 48 hours in advance, our policy is to charge
for missed +/ broken appointments at the rate ($50) of a normal office
visit. Please help us serve you better by keeping scheduled
We appreciate your concern in our need to enforce these policies in
order to deliver to you, our valued patient, continued optimal care.
Please let us know if you have questions or concerns.