Serving Middlebury, Indiana
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New Patient Information

CVF Dentistry > New Patient Information

Welcome to Crystal Valley Family Dentistry!

Our team is dedicated to assisting our patients with their dental needs. We also understand the financial commitment that may be required attain optimal dental health. As a result, we have established the following guidelines to better aid and inform our patients of their financial responsibilities.

Payment Options

We expect payment in full for the services provided at each visit. This is done to help minimize billing and collecting expenses, which become very costly and time consuming, taking away from our primary concern–you! Several payment options available are cash, check, bank card or payment plan. For those with more extensive dental needs, we have joined with a credit lending service to allow for some payment plan options. Please ask for more information.

Insurance

As a courtesy to our patients with insurance, our office will file claims on your behalf and accepts assignment of the estimated insurance benefits. However, you will be responsible for any services provided that are not covered by your insurance, and for any fees that are above the amount payable by your benefits program. In the event your insurance provider denies a claim or pays less than expected, you are responsible for the remaining balance, which is due before your next appointment. Any balance remaining 60 days after insurance has been filed is due before your next appointment and service charges may apply. Please understand the benefits belong to you and it is your responsibility to ensure that you are receiving appropriate reimbursement under the terms of your plan.

Our practice accepts most dental insurance programs, including non-managed care, indemnity (traditional) and PPO out-of-network. We are participating providers with Health Resources Insurance, also known as Dental Health Options, Delta Dental Premier Plan, Anthem BCBS 300 plan, as well as Cigna Dental PPO.

Thank you in advanced for your understanding and cooperation with these policies. Should you have any questions regarding these or other policies, please feel free to discuss them with us.

We appreciate the opportunity to be your dental health provider and to assist you with your dental needs.

Patient Forms

If you are a new patient to our office, the attached files contain our new patient bundle with forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

New Patient Form
Privacy Policy Form

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Payment Options

For your convenience, we accept cash, personal checks, money orders and major credit cards. Payment is expected at the time services are performed. When more extensive dental care is necessary, financial arrangements can be made with our office.

Insurance

As a service to our patients, our practice accepts most dental insurance programs, including non-managed care, indemnity (traditional) and PPO out-of-network.  We are participating providers with Health Resources Insurance, also known as Dental Health Options, Delta Dental Premier Plan, Anthem BCBS 300 plan, as well as Cigna Dental PPO. Our accounting staff will prepare all the necessary forms for your dental benefits. However, we remind you that your specific policy is an agreement between you and your insurance company. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. Our staff will gladly submit a pre-treatment estimate to your insurance company so that you will know what your benefits will be.

The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. 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 available. Also, some companies take care of claims promptly while others delay payment for several months.