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SLEEP APNEA & DENTAL TREATMENT 
CENTER OF SCOTTSDALE
McDOWELL MOUNTAIN MEDICAL CENTER
9377 E. Bell Road
Suite 107
Scottsdale, Arizona 85260
480-419-1400
Dr. T.R. "Rick" Lawson, DDS
Diplomate American Academy of Dental Sleep Medicine
FINANCIAL POLICY
The Sleep Apnea & Dental Treatment Center of Scottsdale would like to thank you for choosing our office for your Sleep Apnea and Dental treatment.
We will assist you in obtaining the maximum insurance benefits to which you are entitled: however, the agreement of your insurance company to pay for your care is a contract between your insurance carrier and you.
As a courtesy to our patients, we are happy to file your insurance claim(s). We can only provide you with an ESTIMATE of your insurance plan benefits. Guarantee of Coverage/Benefits and Payments can only be determined when the claim is processed by your insurance company. If any changes are made by your insurance company, the patient is responsible for any difference.
If your insurance company has not paid the claim in 60 days, the PATIENT is FINANCIALLY RESPONSIBLE for all services provided by The Sleep Apnea & Dental Treatment Center of Scottsdale/ Thomas R. Lawson, DDS. Any outstanding balance after 60 days, will accrue interest at the rate of 1.5% per month. In this case, the PATIENT would need to contact their insurance carrier for resolution/reimbursement.
WE ACCEPT THE FOLLOWING
FORMS OF PAYMENT
I have read and understand and agree to the financial policies as stated above.
Signature Date .
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Comprehensive Sleep Evaluation
