Our Financial Policy

Thank you for choosing Glen Ellyn Pediatric Dentistry for your child’s dental care. As we anticipate a long-term relationship with our patients and their families, keeping current in communication and payment is important.

  • It is our goal to offer high quality, affordable dental care to children of all ages and abilities.
  • Payment at the time of service is expected. We take payment in the form of cash, money order, personal check, insurance company check, and credit card (Discover, Visa, MasterCard and American Express).
  • We accept credit card payments over the phone. and we can set up payment plans
  • Our services remain the same price for everyone, regardless of insurance coverage.
  • We can file dental insurance claims for you and accept assignment of payment to our office. We have a traditional “fee for service” structure, and the parent who authorizes dental care is responsible for payment on the account.


Payment Methods

When your child has been examined and the pediatric dentist has determined his/her treatment needs, we will provide you with a copy of the treatment plan and the estimated costs. The parent who authorizes dental care is responsible for payment on the account.

As each child has a customized treatment plan, we can discuss your specific questions in person. When scheduling an appointment for dental care with sedation in the dental office or the hospital, a down payment is needed.

If you have dental insurance:

  1. Please verify that the insurance data we have on file for you is correct. With accurate insurance information, we can obtain a pre-estimate from your insurance company and submit the bill to them, on your behalf.
  2. Please know the terms of your own policy. Your policy will apply its rules to our billed prices. Please be prepared to pay your portion due to us.
  3. We take estimated co-payments at the time of service, and we will bill you for the balance due after insurance has paid.
  4. Your insurance processes our claim and gives you notice of the result (estimation of benefits, or “EOB”). Please read their details and pay the balance due to us. Insurance will usually process within 30 days.
  5. We are “in-network” only with Delta Dental Premier PPO. We are “out-of-network” for all other companies. For many of the companies, the “out-of-network” payments depend on how they accept our fees. We can provide our fees for service, and you can see how your policy will handle them.

If you do not have dental insurance:
Please pay the balance due at the time of service. We accept payment in the form of cash, check, and credit cards. We can provide receipts that meet the requirements of  Flexible Spending Accounts  (FSA) and Health Savings ( HSA) accounts.

Medical Insurance
At the present time, we are not able to send a claim to medical insurance companies using medical coding.  We can send a dental services claim to a medical insurance when requested. 

Other Details of Our Financial Policy

Billing Statements
We will send one statement to you by mail at no charge. Repeated billing statements will have a $20 billing fee applied. The statements are sent 20 days after the account activity.

Bounced Checks
If you present a personal check that bounces, you will be asked to make payment in full at time of service by cash or money order only. You will not be eligible to have assignment of insurance benefits. A $25 charge will be made for any bounced checks. You will be responsible for the cost of collection (33%) and attorney's fees on any past-due balance that is directed to our collection agency.

Broken Appointments
A fee of $25 per child is applied to your account for each broken appointment.

Again, thank you for choosing Glen Ellyn Pediatric Dentistry for your child’s dental health needs. We look forward to caring for your children for many years to come.