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1777 E. Clark St. Suite 240 • Pocatello, ID 83201

Financial Arrangements

Insurance

Please be aware that no insurance company attempts to pay fully for treatment. Some companys have a limited lifetime maximum or have an exclusion clause in your plan. It is your responsibility to pay the deductible amount, co-payment or any other balance not paid for by your insurance company at the time of service.

We understand that questions can arise on insurance matters, please feel free to discuss insurance and financial matters with our business staff. The agreement of the insurrance company to pay for your treatment is a contract between you, the insurance company and your employer. Please bring your insurance card, indicating your insurance companys address, phone number, group number, and provider number with you to your appointment so we can copy and place it in your file. If you have questions bring in your insurance booklet (if available) and we can evaluate your plan for your specific benefits in connecton with your treatment.

Commitment of Financial Arrangements

We believe that our commitment to your excellent health care requires a commitment by you to pay for those services as agreed.

Finacial Commitments

You will be given an estimate of treatment cost and asked to discuss financial arrangements with our treatment coordinator. Please understand that insurance is not considerd a substitute for your payment.

We offer a discount for cash payment when treatment begins.

We accept 3 equal monthly payments begining with acceptance of treatment.

We accept all major credit cards for your convenience and we offer several alternative financing options. The plans we offer have competitive or no interest rates.

Ask us and we will be happy to share the options with you.

Copyright 2011 The TMJ Sleep Center • 1777 E. Clark Suite 240 • Pocatello, Idaho 83201

Phone: 208-234-PAIN (7246) • Fax: 208-232-0207