TERRY E ZERVOS.D.D.S.,P.A. Dunedin, FL 34698
434 Main Street    (727)736-3032

E-mail: Info@zervos. us

General, Cosmetic and Implant Dentistry Qualify Oriented and Dedicated to Excellence

Dear Patient:

We have prepared this letter to help you better understand the complexities of dental insurance; we realize how confusing it can be. This office is happy to cooperate with individuals who are covered by dental insurance. We only ask that you carefully read your policy to be sure that you are fully aware of any restrictions that apply to the benefits provided.

We would like to highlight a misconception – dental insurance was not designed to pay for all dental care. Most contracts have limits and/or various degrees of co-payment. Your policy may base its allowances on a fixed fee schedule which may or may not coincide with our usual fees. You should be aware that different insurance companies vary greatly in the types of coverage they make available. All levels of payment by insurance companies, including allowed fees, usual and customary (UCR), are governed by the premiums paid. They have nothing to do with the actual charges. Also, some companies pay claims promptly, and others delay payment for many months.

The fees we charge for services rendered to those who are insured are our usual and customary fees charged to all patients for similar services. Our fees are based upon a combination of our costs, our time, and our constant dedication to supplying our patients with the highest quality dental care. The treatment recommended by our office is never based on what your insurance company will pay; your treatment should not be governed by your insurance contract.

However, it should be understood, that the dental insurance contract is between the insurance company and the patient, whom bears the ultimate financial responsibility. It is not a contract between the dentist and the insurance company. Since we have no say in the selection of your insurance company (nor do we feel we should), we have no control over when we shall be paid by your carrier for our services.

Therefore, we ask that you view your insurance realistically as a device that reimburses you for dental expenses. We will fulfill our obligation by completing all forms pertaining to your claim and sending them promptly to your company to help you obtain the reimbursement you may be entitled to receive, as a courtesy to you.

We hope this information has been helpful. Please take the time to review your contract thoroughly so we may best serve you. As always, you may feel free to ask any member of our staff for clarification on services, billing, and insurance.

Sincerely,

Dr. Terry E Zervos DDS PA

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Patient/Responsible Party Signature                                                      Date