5 Crain Highway N
Glen Burnie, MD 21061
Phone (410) 969-9300, Fax (410) 969-9311
www.glenburniedentalgroup.com

Patient Business Policy

Welcome to Glen Burnie Dental Group 

Glen Burnie Dental Group provides quality dentistry for people ages 4 and up.  We offer a wide range of dental services, including preventive, cosmetic, restorative and reconstructive dentistry.  

We pride ourselves on our patient-centered practice.  We do everything possible to make dental visits pleasant for our patients.   In our continuing efforts to provide comprehensive dentistry to you, our valued patients, we ask that you become acquainted with our organization policy.  If at any time you have any questions, please feel free to ask our team members, so that we may better serve you.  

All recommended treatments are in the best interest of our patients.  We will assist you in your payment options to help you receive the highest quality of dental care treatment that is necessary for your needs.  Please note that no two mouths are alike. We customize your treatment to suit your needs.

Dental Insurance
We accept assignment of estimated insurance benefits as a courtesy to our patients.  Please note that your dental insurance is a contract between you and the insurance company. It is not a contract between the dentist and the insurance company.  Our usual and customary fees, which are modest within our geographical area, are a reflection of our commitment to excellence.  All estimated co-pays and deductibles are due at the time of service.  

All insurance claims are submitted within 24 hours. However, we have found that some insurance companies do not reimburse us within an adequate timeframe. After 30 days, we will re-submit the claim as an added courtesy to you. If the claim is still not paid 60 days later, you will be responsible for the total amount. We strongly recommend that you follow up with your insurance company to ensure prompt processing of claims. 

Balances remaining after sixty (60) days may accrue interest and may be sent to a collection agency.

Glen Burnie Dental Group will accept secondary dental benefits per the guidelines of the respective insurance companies. We recommend that you read your policy carefully to be fully aware of any rules and restrictions that may apply to your dental benefits. Glen Burnie Dental Group will not accept secondary dental benefits from HMOs or Reduced Fee dental plans.  

In the event that insurance does not cover your treatment or is cancelled/terminated for any reason, or cannot be verified for any reason, the patient or responsible party will be responsible for the entire fee amount including the insurance portion.

Emergency patients
Please note that our policy requires verification of insurance.  In the event that we are not able to verify your insurance information, payment will be due at the time of service.  We will assist you in submitting a claim to your insurance company, so that the insurance company will reimburse you directly for your visit. If the insurance payment is sent to our dental center, any applicable credit will be refunded to the patient. 

Appointments Cancellation Policy
We reserve appointment times especially for you and for your dental care needs.  We strive to give each patient a courtesy call one to two days in advance of their scheduled visit.  However, you are expected to keep your appointment time with or without the courtesy call. Therefore we ask your consideration and that you kindly give 48-hour notice if you are unable to keep your appointment.  Please note that if 48-hour notice is not given, there may be a $50 per hour for a broken appointment fee. A broken appointment is a loss to yourself, your dentist and his team members, and to another patient who could have had that appointment time. We reserve the right to terminate your relationship with our office after repeated broken appointments without 48-hour notice. 

Initial Visit
Please be advised that it is our policy not to perform a cleaning when a patient has gum disease. As gum disease is a very serious problem and should be treated without delay, we feel this policy is in the best interest of the patient. Our initial fee includes the exam and preliminary x-rays (up to 4 PA’s or 4 Bitewings only- if additional x-rays are needed you will be charged our normal per x-ray fee). There will be no refund of the initial visit fee. 

Patient Identification
We require a picture ID for all patients over the age of 18 (driver’s license, school ID or military ID). 

Preferred Method of Payment
For your convenience we accept Cash, ATM/Check cards and all Major Credit Cards (American Express, MasterCard, Visa, Discover), and Checks (with proper I.D.).  We also use an automated retriever check service, which electronically withdraws the payment from your account or insures payment.  There will be a thirty-five dollar ($35) returned check fee applied to your account in the event that the bank denies your check for any reason.  Payment will be expected within 48 hours of notice from the bank, in cash or by credit card.

As an added courtesy we also offer a revolving line of credit through a third party (upon credit approval).  This line of credit allows you to start treatment today and spread payments over a comfortable period of time.

*Our fees are explained and disclosed prior to receiving any treatment plan or services.  Our fees are reasonable and commensurate with the knowledge, skill, experience and service provided by our dentist and staff.

Deposit
We require a deposit to be made for hold any appointment time.

Refund policy
1	Once services are performed, refunds cannot be made for those services.  
2	All electronic payments (VISA, MASTERCARD, AMERICAN EXPRESS, DISCOVER) will be refunded within ten (10) business days, not including weekends and holidays.
3	All cash and check payments will be refunded, by company check, within thirty (30) business days, not including weekends and holidays.
4	A “Release of Claims” form must be signed before refunds are issued. 

Duplication Fee
In the event that you should request a duplication of your x-rays, you are required to fill out a release form. There will be a twenty two dollar ($22) charge for panoramic and a twenty-five dollar ($25) charge for full mouth x-rays, six dollars ($6) for each bitewing x-ray and each single periapical x-ray. All x-ray duplication requests require at least 48-hour notice to process.  Payment is due upon request of duplicating services.

Agreement to pay
In the event there is a default of payment on any balance due, Glen Burnie Dental Group will make all necessary collection efforts to secure the balance due.  This may include reporting a delinquency to a credit report agency and taking legal action.  Any additional costs incurred will be charged to the patient or responsible party.

Agreement to resolution of concerns
By signing for, and accepting this policy, I understand that I am entering into a contractual relationship with Glen Burnie Dental Group for professional care. I further understand that meritless and frivolous claims for medical/dental malpractice have an adverse effect upon the cost and availability of healthcare, and may result in irreparable harm to a healthcare provider. As additional consideration for professional care provided to me by Glen Burnie Dental Group, I, the patient/guardian and/or my representative agree not to advance, directly or indirectly, any false, meritless, and/or frivolous claim(s) of medical/dental malpractice against Glen Burnie Dental Group. 
Furthermore, should a meritorious medical/dental malpractice case or cause of action be initiated or pursued, I (the patient) and/or my representative agree to use expert witness (es) who practice primarily in the same specialty as the dentist. Furthermore, I agree that these expert witnesses will be members in good standing of and adhere to the guidelines and / or code of conduct defined for expert witnesses by the Dental Board of the State of Maryland.

In further consideration for this, the dentists at Glen Burnie Dental Group agree to the same stipulations.
Patient/guardian and Glen Burnie Dental Group acknowledge that monetary damages may not provide an adequate remedy for breach of this Agreement.  Such breach may result in irreparable harm to Glen Burnie Dental Group’s reputation and business.  Patient/guardian and Glen Burnie Dental Group agree in the event of a breach to allow specific performance and/or injunctive relief.