No Dental Insurance? We Can Help!
We know that dentistry is expensive and often that means people don’t take care of their teeth. Our office is happy to offer a membership to make great dental care more affordable. Take care of your mouth by taking advantage of our great in-house membership.
Coverage Includes
- New Patient/Comprehensive Exam
- Periodic Exams (two per year)
- Emergency Exam (one per year)
- Cleanings (two per year)
- Perio Maintenance (three per year)
- FMX (1 every 5 years)
- Panoramic X-ray (1 every 5 years)
- Bitewing X-ray (1 set per year)
- Periapical X-ray (1st film & 2 additional per year)
- Fluoride (2 per year)
- 15% Discount on Dental Procedures
Plan Benefits
- No Preauthorization Required
- No Annual Limits or Deductibles
- No Waiting Periods or Pre-Existing Exclusions
Membership Dues
- Child Patient $504 or $42 a month on autopay
- Adult Patient $600 or $50 a month on autopay
- Perio Patient $708 or $59 a month on autopay
Terms and Limitations of the Plan
- Effective date is the date signed up and renewal date is 1 year from said sign-up date.
- This is a dental discount plan and not dental insurance. It cannot be combined with any dental insurance or other offers.
- This plan is only good at Patelzick Family Dental. Therefore, if you are referred to a specialist, they will not offer this discount.
- Rates are subject to change annually.
- Should there be any dental treatment needed following any type of injury where a lawsuit and therefore outside medical, care, or workman’s comp type insurances are involved, this discount plan cannot be used.
- This plan is non-transferable. Family members cannot be substituted in for another.
- This plan is non-refundable. No refunds are given if patient chooses not to use their benefits.
- Payments for services not covered at 100% are due at the time of service. If patient chooses to extend payment through Care Credit then discount is reduced to 5% due to merchant fees.
- A fee will be incurred for each broken appointment without a 48 hour advanced notice. $45 for cleanings and 25% cost of treatment for other services.
- Discount applies to services, not products.
Click here to download pdf form.
Give Us A Call: (805) 482-1558