Financial Information

Thank you for choosing Portage Pediatric Dentistry as your child's dental health care provider. Our goal is to provide superior dental care for your child while communicating costs with complete transparency. Below is our Financial Policy, which we require to be reviewed and signed before treatment.

Payment Policy

Payment is due at the time services are rendered. If we participate with your dental insurance plan, we will collect an estimated coinsurance or patient portion at the time of service.

We accept cash, Visa, MasterCard, American Express, and Discover.
Third-party financing options may be available, subject to approval.
Depending on your child’s treatment needs, care may be recommended in a surgical setting under the supervision of a licensed anesthesiologist. In such cases, additional fees may be charged by the facility and/or its contractors. These charges are separate from Portage Pediatric Dentistry& Orthodontics, and by signing below, you acknowledge responsibility for any uninsured or unpaid amounts.
Balances not paid in full within 90 days are subject to a $25.00 late fee.

Minor Patients

Payment for treatment provided to a minor is the responsibility of the adult accompanying the child at the time of service.
In cases of divorced or separated parents or guardians, it is your responsibility to make all financial arrangements with the other party prior to your child’s appointment.
The parent or legal guardian signing this agreement accepts full financial responsibility for all costs associated with the child’s care, including applicable service charges, collection fees, and court costs incurred on delinquent accounts.

Dental Insurance

As a courtesy, we will submit your child’s dental insurance claims on your behalf and accept assignment of benefits when applicable.

Your dental insurance policy is a contract between you and your insurance carrier. While we may provide treatment estimates, it is ultimately your responsibility to understand your plan’s benefits, limitations, exclusions, and requirements.
Insurance estimates are based on information available at the time and are not a guarantee of payment or coverage. Any remaining balance after insurance processing is the responsibility of the parent or guardian.

Missed Appointments

If you need to cancel or reschedule an appointment, we require at least 24 hours’ notice (48 hours for surgical appointments) to allow us to accommodate other patients. While we understand that emergencies may arise, repeated missed appointments, late arrivals, or failure to provide adequate notice may result in dismissal from the practice.

Convenient Online Services

With just the simple click of a mouse, our secure online service allows you to:

Click a Secure link to complete the required forms
We also provide email or text appointment reminders
View your child’s appointment and account information at any time
Check your payment history and see current charges
Print out flex spending reimbursement and tax receipts

If you do not have a patient login, please let us know at your little one’s next appointment, and we will gladly help you set up your personal account.

(269) 323-8016

PORTAGE, MI