Atlanta West Dentistry

This patient was seen in our office for 4 different visits between Feb 2019-Sept 2019. The patient was charged our usual and customary fee of $102 for a comprehensive oral exam and the insurance covered $32 of this fee leaving the remaining $70 as the patient responsibility. They were charged $152 for complete series of intra-oral images (x-rays) which insurance covered $70 leaving the remaining $82 as the patient responsibility. They were charged $89 for an adult prophylaxis (cleaning) which insurance covered $49 leaving the remaining $40 as the patient responsibility. The total outstanding patient responsibility is $192. The patient has received several statements showing the balance owed as well as copies from the insurance company showing the explanation of benefits along with the patient responsibility. The patient also signed a form stating that they understood that fees are due and payable on the date that services are rendered and agreed to pay all such charges incurred in full immediately upon presentation of the appropriate statement explanation of benefits or check. The financial coordinator has spoken to this patient and explained all of the above verbally as well as provided details in writing via email. Copies of the explanation of benefits from the patients insurance company as well as the signed financial document are available upon request.