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POLICIES

If you don’t have insurance, or are unsure if your insurance is accepted, please give us a call. We do accept most insurance plans, and we will process the claim for you.

Credit Policy

 

Patients without a dental benefit plan have several payment options:

 

  • 5% Cash Discount – This discount applies to cash or check payments paid in full for services rendered the same day.

  • Credit Card – We accept all major credit cards including American Express, Discover, MasterCard and Visa.

  • Payment Plans – We offer low and no-interest payment plans through Care Credit.

 

Patients with a dental benefit plan:

 

It is important to remember that your dental “insurance” is a benefit plan with a contract between your employer and the benefit company. It is your responsibility to know what your benefits are and what you are allowed in any particular year.

 

As a service to our patients, we are happy to offer to submit your claim to your benefit plan for you. Any copays, deductibles or fees for non-covered services that are your responsibility will be due upon receipt of your first statement.

 

Any balance due after 60 days will be subject to service charges of 18% APR.

Missed Appointments

 

We understand that life can be unpredictable and that at times, you may need to reschedule your appointment. We ask that you kindly give at least 24 hours notice when changing an appointment. Please understand that we have many loyal patients and that your appointment is reserved for you.

 

If you miss one appointment without 24 hours notice, we will kindly reschedule. After a second missed appointment, we reserve the option of charging a $45 fee for the missed appointment. After three failed appointments, we may ask to terminate our relationship with you as a patient. We will offer emergency services for a period of 30 days, giving you time to find a new dental home.

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We are grateful you have chosen Thief River Falls Family Dentistry for your oral health care needs and look forward to serving you. If you have any questions concerning this financial policy, please contact Lori Johnson during working hours and she will be happy to discuss them with you.

NONDISCRIMINATION NOTICE

Notification For Language Assistance Services For Individuals With Limited English Proficiency (PDF)

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Appendix A to Part 92 – Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and Nondiscrimination Statement: Discrimination is Against the Law.

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Thief River Falls Family Dentistry complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.

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Thief River Falls Family Dentistry does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.

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Thief River Falls Family Dentistry:

 

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:

    • Qualified sign language interpreters

    • Written information in other formats (large print, audio, accessible electronic formats, other formats)

  • Provides free language services to people whose primary language is not English, such as:

    • Qualified interpreters

    • Information written in other languages

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If you need these services, contact Dr. Michael Eickman. If you believe that Thief River Falls Family Dentistry has failed to provide these services or discriminated in another way on the basis of race, floor, national origin, age, disability or sex, you can file a grievance with:

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Dr. Michael Eickman
Thief River Falls Family Dentistry
PO Box 655
Thief River Falls, MN 56701

 

You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, Dr Michael Eickman is available to help you.

 

You can also file a civil rights complaint with the US Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

 

US Department of Health and Human Services
200 Independence Ave, SW
Room 509F, HHH Building
Washington, DC 20201
1.800.368.1019, 800.537.7697 (TDD)

 

Complaint forms are available at www.hhs.gov/regulations/complaints-and-appeals/index.html

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