Here you find which insurances and payment plans Dr. Michael L Stepovich accepts.

A Payment Plan To Smile About

Payment Options

Orthodontic treatment is an excellent investment in the overall dental, medical and psychological well being of children and adults, and financial considerations should not be an obstacle to obtaining this important health service. Being sensitive to the fact that different needs in fulfilling their financial obligation, we are providing the following payment options.

Option A : Orthodontists Fee Plan

Outside financing available·
No Initial Payment
Take up 36 months to pay with payments as low as $99.00 per month that includes a minimal finance charge.
48 month option available for multiple family members· Significant tax advantage·
Prepayments can be made anytime.
Fast, confidential service by phone Good credit standing requires·
The toll free number is 1-800-637-3393

Option B : Office payment In Full

A bookkeeping credit of 8% is given for payments in full at start of treatment by cash or check resulting in a one-time payment.

Option C: Office Payment Plan

An initial payment is due when treatment begins, with the balance paid in 30 monthly payments.

Insurance

If your insurance policy offers orthodontic coverage, we will help you determine the coverage available to you and make arrangements for payment of your account dependent on your insurance coverage. Treatment time differs from patient to patient. These payments options may not correspond to the estimated treatment time and the payment plans are merely provided for your convenience.

Click here for a printable version of the Insurance Information section.

Insurance Information
Name of Insured_________________________________________________________________			Relationship to Patient________________
Birthdate______________________	Social Security__________________	Date Employed_______________
Name of Employer______________	Union or Local #___________	Work Phone_____________
Address of Employer____________	City_____________________	State/Prov.______________	ZIP/Post. Code_______
Insurance Company_____________	Group #__________________	Policy/ID #______________
Ins. Co. Address_______________	City______________________	State/Prov.______________	ZIP/Post. Code_______
How Much is your Deductible?___________________	How Much Have You Used?____________________	Max. Annual Benefit_________________

DO YOU HAVE ANY ADDITIONAL INSURANCE? Yes No		IF YES, COMPLETE THE FOLLOWING:

Name of Insured_________________________________________________________________			Relationship to Patient________________
Birthdate______________________	Social Security__________________	Date Employed_______________
Name of Employer______________	Union or Local #___________	Work Phone_____________
Address of Employer____________	City_____________________	State/Prov.______________	ZIP/Post. Code_______
Insurance Company_____________	Group #__________________	Policy/ID #______________
Ins. Co. Address_______________	City______________________	State/Prov.______________	ZIP/Post. Code_______
How Much is your Deductible?___________________	How Much Have You Used?____________________	Max. Annual Benefit_________________

			Yes	No
1.	Do your gums bleed while brushing or flossing?
2.	Are your teeth sensitive to hot or cold liquids/foods?
3.	Are your teeth sensitive to sweet or sour liquids/foods?
4.	Do you feel pain to any of your teeth?
5.	Do you have any sores or lumps in or near your mouth?
6.	Have you had any head, neck or jaw injuries?
7.	Have you ever experienced any of the following problems in your jaw?
		Clicking?
		Pain (joint, ear, side of face)?
		Difficulty in opening or closing?
		Difficulty in chewing?
8.	Do you have frequent headaches?
9.	Do you clench or grind your teeth?
10.	Do you bite your lips or cheeks frequently?
11.	Have you ever had any difficult extractions in the past?
12.	Have you ever had any prolonged bleeding following extractions?
13.	Have you had any orthodontic treatment?
14.	Do you wear dentures or partials?
15.	Have you ever received oral hygiene instructions regarding the care of your teeth and gums?
16.	Do you like your smile?

Authorization and Release

I certify that I have read and understand the above information to the best of my knowledge. The above questions have been accurately answered. I understand that providing incorrect information can be dangerous to my health. I authorize the dentist to release any information including the diagnosis and the records of any treatment or examination rendered to me or my child during the period of such Dental care to third party payers and/or health practitioners. I authorize and request my insurance company to pay directly to the dentist or dental group insurance benefits otherwise payable to me. I understand that my dental insurance carrier may pay less than the actual bill for services. I agree to be responsible for payment of all services rendered on my behalf or my dependents.

X____________________________________________________
Signature of patient (or parent if minor)

Doctor's Comments __________________________________________________________________________________
___________________________________________________________________________________________________
Signature________________________________________________________________________	Date______________

Click here for a printable version of the Insurance Information section.

Accepted Insurance Companies If your Orthodontic Company is listed below, our office will happily file for your benefits.
AETNA Blue Cross Blue Shield of California Cigna Conn. Gen. Life Ins Delta Dental of California Delta Dental (of most other states ) Great West Life and Annuity Guardian Life Ins Health first TPA Met Life Dental	Motorola Mutual of Omaha Companies Phoenix Principal Life Ins. Co Prudent Buyer Dental Prudential Prudential Health Care Select Benefit Admin. Inc. United Administrative Ser. United Concordia United Health Care
Other Orthodontic insurance could be added to this list.

Return to Top