Insurance Information Update Form

Thank you for choosing Elias Dental as your dental care provider. We are committed to your treatment being successful. Please take a moment to provide us with your current Dental Insurance information. It is your responsibility to make sure we always have the correct information on file, so billing and payment goes smoothly. This form is to be utilized by those updating their dental insurance with Elias Dental. Please review our Insurance Financial Policy below.

Insurance

Please remember that your insurance is a contract between you and your insurance company. We are not a party to that contract. It is your responsibility to inform the office of any insurance changes prior to being seen. Failure to provide the office with correct or updated insurance for billing may result in all charges becoming your financial responsibility. As a courtesy to you, our office provides certain services, including pre-treatment estimates and billing. It is physically impossible for us to have the knowledge and keep track of every aspect of your insurance. It is up to you to contact your insurance company and inquire as to what benefits your insurance plan has as well as making sure Dr. Elias is a preferred provider. Please be aware that some or perhaps all the services provided may or may not be covered by your insurance policy/plan. Any balance is your responsibility whether your insurance plan pays any portion.