Insurance Information and Forms

As a courtesy, our office will assist patients in accessing their dental insurance benefits by filing a claim form on their behalf. Dr. Moore does not participate in any restrictive insurance programs; therefore you will never see her name on any "insurance lists". Fees for services rendered are paid by the insurance companies at "usual, customary, & reasonable" (UCR) rates. For example, if a basic service such as a filling or simple extraction has plan coverage at 80%, the insurance company will pay that 80% on what they deem to be a customary charge, as opposed to the actual fee that the dental office submits. Each insurance company has their own schedule of UCR fees. This is how they control their losses. Dr. Moore will never compromise on quality, or be guided by an insurance company's UCR schedule.

In addition to an estimated patient portion (payable at the time service is rendered), the patient is responsible for whatever costs the insurance company does not cover. At the time of service, the patient is given an estimate of insurance benefits expected on that service, and the estimated patient portion for same. These are only estimates. After an insurance claim has been "settled", or paid, the patient is fully responsible for any remaining balance.

New Patient Form

Please print the above form, fill out and bring with you to the office on your appointment date.

You will need Adobe Acrobat Reader. You can get it here if you do not already have it.

We Gladly Accept:

  • Visa
  • MasterCard
  • American Express
  • Discover
  • Personal Checks
  • Cash
  • Care Credit