Insurance Update Form

Action Required

Thank you for choosing Classic Dental Group. We are looking forward to caring for your smile!

While preparing for your upcoming visit, we found that your current insurance plan is out-of-network with our practice. To ensure we handle your account exactly how you prefer, please review the three options below, then complete the form by selecting the option that best fits your needs.

Option 1: Cancel Service (Find an In-Network Provider)
We understand that staying in-network is often the most cost-effective choice for patients. If you prefer to seek care from a dentist within your network, please let us know now. We wish you the very best with your dental health and thank you for considering us.

Option 2: Pre-Treatment Estimate (Standard Processing)
If you are not in a rush, we can submit a pre-treatment estimate to your insurance company before your first visit. This allows us to see exactly what your out-of-pocket responsibility will be. Once we receive their response (usually within 2-4 weeks), we will contact you to discuss the costs. At that point, you can decide if you would like to move forward with your appointment.

Option 3: Priority Scheduling (Pay & Reimburse)
If you would like to be seen as soon as possible, you may pay for your initial visit in full at the time of service. We will then submit the claim to your insurance company on your behalf. Once your insurance company processes the claim, any reimbursement they send to our office for that visit will be refunded directly back to you.

Insurance Update Form