New Patient Forms
We have made our new patient forms available to you online. For your convenience, we recommend completing these forms before your first appointment.
Dental Insurance and Financial Assistance Policy
New Image Dentistry’s primary goal is not to allow the cost of treatment to prohibit you from benefiting from the quality care you need or desire. If you have dental insurance we strive to maximize your insurance benefits and make any remaining balance as easily affordable as possible. For uninsured patients Dr. Holland created In Office Dental Plans to facilitate access to affordable care. Additional efforts to achieve this goal include:
- Participation as In Network PPO Providers for most major dental insurances. We will electronically file on your behalf on the date of your appointment. Our team exhausts all efforts to defend your access to the benefits of your policy.
- New Image Dentistry In Office Dental Plans. Annual plan that covers cleanings, fluoride, xrays and exams, as well as significant savings on treatment. Free custom home whitening trays included! See details on the In Office Dental Plan page.
- CareCredit. With CareCredit you can spread your payments out over a designated time frame. CareCredit offers many low- and no-interest plans. You can apply online at www.carecredit.com and receive an immediate line of credit.
- Citi Health Card. Third party financing that offers flexible payment plans for the health care treatments your family needs. You can apply online at www.citicards.com
- OrthoBanc. A third party financing program that manages monthly payment plan drafting for patients in extended treatment and orthodontic cases. For more information visit www.orthobanc.com
- Pre Payment “Lay Away” Option. Patients may negotiate a “lay away” style payment plan in an effort to cover their portion prior to initiation of treatment.
- Split Payment Option. Payment may be split if your treatment takes more than one visit.
- We accept the following forms of payment: Cash, Check, MasterCard, Visa, American Express and Discover.
- 5% discount on CASH payments for uninsured services on or before date of treatment.
- 10% discount for uninsured senior patients not enrolled in New Image Dental Plan
Our fees are based on the quality materials we use and the time, effort and skill required in performing your needed treatment. We charge what is the usual and customary for our area. We will assist you with your benefit eligibility before treatment to help you calculate your costs and maximize your insurance. We will be sensitive to your financial circumstances and do everything possible to help you achieve optimal oral health.
Payment for services is due at the time services are rendered unless prior arrangements have been made. Checks that are returned to our office from your financial institution are subject to a $25.00 returned check fee. This fee covers the processing fees that are charged to our office.
Ultimately, you are responsible for payment regardless of your insurance company’s coverage. We cannot guarantee any estimated coverage. Because the insurance policy is an agreement between you/or your employer and the insurance company, all patients are directly responsible for all charges incurred at New Image Dentistry.
We would be happy to discuss our charges and how they relate to your particular situation. We also realize that temporary financial situations may affect timely payment of your account. If such problems do arise, we encourage you to contact us promptly for assistance in the management of your account. Most often, financial misunderstandings can be managed with a phone call. Please feel free to contact our wonderful staff at any time to discuss any concerns you may have.
Due to the extensive amount of time our staff and doctors devote to preparing and reserving uninterrupted time for reservations over 2 hours, we require a deposit of $150.
Rescheduling / Missed Appointment Policy
Our practice is dedicated to quality care and exceptional service. Our doctors and team spend extensive amounts of time preparing for your visit. Broken and missed appointments create scheduling problems for our team as well as other clients. If you find that you must change your appointment, we require a minimum of 24 hours notice.
If proper notice is not received a fee of $55.00 will be charged.
If you ever have questions about financial arrangements, please don't hesitate to call our office in San Antonio. Our financial coordinator will be happy to explain your options and help you in any way possible.