Terms and Conditions
Melissa L. Welty, DDS
6531 FM 2920
Spring, TX 77379
Telephone: Spring Office Phone Number (832) 717-0595 | Fax: (832) 717-0105
Thank you for choosing our office for your dental needs. We are glad to have you at our office and committed to providing you with the excellent care and service you deserve. Our policies outlined below are based on an open and honest discussion of recommended treatment options, respective fees, and financial capabilities. Please take a moment to look over and sign our office policy and financial guidelines.
- Regarding Your Appointments
We understand that your time is valuable, and we ask that you respect the time of other patients and the doctor. When making appointments, especially during high demand hours (i.e. early morning and late afternoon), please give at least 24 hours notice to cancel or reschedule. We reserve the right to either require a 50% deposit for future appointments, or a $50 fee for continuous missed and failed appointments without prior notice.
- Signature on File
Your signature authorizes Dr. Welty and staff to use your name on any/all claims or documents that relate to your insurance benefits due to yourself and your dependents. You are also authorizing the release of any information related to any claims to all your insurance companies or other related parties. You are authorizing payments, otherwise payable to you, to be made directly to Dr. Welty. Your signature also states that we may use any copy of your authorization in place of the original.
- Regarding Your Insurance
Our office is committed to helping you maximize your insurance benefits. Insurance is meant to help you in covering the cost of dentistry, not providing 100% coverage. We will be delighted to file your claims directly with your insurance carrier for services where eligibility has been verified. Payments of co-insurance, deductibles, or fees for non-covered services are due before or at the time of services. We will allow your insurance 90 days to render payment for services performed. If your insurance does not render payment after 90 days, the balance becomes your responsibility, and it will be due in full.
- Regarding Treatment Plans
It is our pleasure to provide each patient with a detailed treatment plan which includes a breakdown of treatment for each appointment as well as a financial estimate of out-of-pocket expenses before any treatment is to be performed. Please understand that this estimate is based on information obtained from your insurance company, which is not a guarantee of benefits or payment. If your insurance does not pay the amount estimated, you will be responsible for the remaining balance.
- SMS Communications
By providing your phone number, you consent to receive SMS communications from our office regarding appointments, reminders, and other pertinent information. Message and data rates may apply. Check with your mobile provider for details. You can opt-out of SMS communications at any time by replying “STOP” to any message you receive from us.
We are not responsible for any delays or failures in the delivery of SMS messages due to network issues or other factors beyond our control.
- Regarding Returned Checks/Past Due Balances/Collections
We gladly accept cash, Visa, Mastercard, Discover, American Express and Care Credit. Any account balance (not including outstanding insurance claims) over 60 days old will begin to accrue interest at a rate of 1.5% a month (18% annually). Failure to arrange payments on any balance over 120 days old will result in outside collections.
If you should have any questions or comments regarding our office policy or financial guidelines stated above, please feel free to contact the office manager. Thank you for your cooperation and welcome to Klein Crossing Dental!