Payment Options

We accept Visa, Master card, Discover, American Express, Lending Club & Care Credit. For your convenience we also can accept credit card payments over the phone. Please note that all Credit Card payments will incur a 4% service fee. There is no service fee for checks, debit card, or cash transactions.

We also have great news for patients who are looking for simple and affordable financing options. Through our relationship with CareCredit and Lending Club, payment has never been easier! Click the links below for an application:

Our Financial Policy

We are committed to your successful treatment without additional worry about your financial
obligations. The following is a statement of our financial policy, which we ask that you read and sign prior to any
visit in our practice.

Financial Obligations:

General Clauses:
It is your responsibility to determine if Dr. William G. Ranucci or Dr. Emil Cappetta participates with
your insurance(s).
You should have a basic understanding of how your dental insurance works.
If we participate with your plan, and if your plan offers coverage/benefits for a procedure, our office
will bill your account up to the maximum allowable negotiated fee as determined by your insurance
company.
If your service is a covered benefit under your plan, the insurance company may pay all or only a
percentage of that reduced/negotiated maximum allowable cost, and you are responsible for the
remaining percentage/difference.
Insurance is a contract between you (the patient) and your insurance company itself; If we happen to
be in-network with your insurance plan, it does not mean that we happen to know the details of the
benefit package you signed up for.
While our office can provide an estimate of any co-pay, this is not a guarantee that your insurance will
cover the remainder of the bill for your treatment. It is your responsibility to know your insurance
percentage coverage, co-pays and out of pocket costs. Whatever percentage of coverage you are
responsible for (and thus any out-of-pocket costs towards that maximum allowable amount) is
between you and the insurance company, based on the plan that you selected.
Please understand that “participating” with a dental insurance plan (being In- Network) means only
that your doctor has agreed to a negotiated and reduced fee for certain, and not necessarily all,
services that we provide.
It is your responsibility to advise our office of any insurance payments or explanations of benefits
(EOBs) you receive regarding your treatment.
Please be aware that some, or perhaps all, of the services provided may be non-covered services
under your particular insurance contract, or may not be considered reasonable and necessary under
Consents & Signatures (Required)
your plan. In those cases, you will be responsible for the non-reduced fee (our regular office fee
schedule amount).
Please be advised that if your doctor does not participate with your insurance carrier, you will be
required to pay in full for any services rendered on the day of treatment, as determined by our
regular office fee schedule. We will submit all claims and proper paperwork to your insurance
company on your behalf, and your insurance company will usually send payment directly to you.

Medical Insurance:
Dr. Ranucci and Dr. Cappetta are not in network with any medical plans. Medical insurance may be
required or considered for certain services such as bony impacted wisdom teeth removal, jaw
fractures, orbital fractures or large cysts/tumors. Some medical insurance plans do not provide
coverage for these treatments, in or out of network. You should also be aware of any medical
insurance deductibles you may have.
If your dental insurance requires your treatment and claims to be submitted to your medical insurer
before they consider the claim, we will submit all necessary information on your behalf and apply any
payments toward your outstanding balance.

Medicare, Medicaid, and State-Funded Insurance Plans:
Neither doctor participates with any Medicare, Medicaid, or state funded plans. These Insurance plans
will not pay for any portion of the services provided in this office. The patient will be responsible for
the total cost of the treatment as determined by our regular office fee schedule. We are NOT able to
submit claims to these insurance plans on your behalf either.

If you do not have insurance:
Patients without insurance are responsible for the full cost of treatment, as determined by our regular
office fee schedule.
Patients with participating dental insurances (“In-Network”) shall pay the amount of their estimated
co-pay and deductible as determined by their plan’s maximum allowable fee schedule at the time of
service.

Other:
All patient balances must be settled within 90 days of the date services are rendered. This is
regardless of whether or not your insurance claim is in progress, pended, or finalized.
If your insurance has not paid their obligated percentage of your balance within that 90 day period,
you will need to pay the remaining balance to our office, and await reimbursement. (see below).
After 90 days the patient is responsible to pursue payment from the insurance company. We will
assist you with this in any way we can. All current documentation can will be provided by mail or
email in order to assist any inquiries.
Any insurance reimbursements paid to us (after your bill is paid in full) will be remitted to you within
30 days of receipt by us.

Patient Acknowledgements:
Patients are responsible for the payment of their own account; You may designate insurance
coverage through another person if you are a participant under his or her plan; however, you should
understand that all financial responsibility remains with the patient.
Minors are unable to enter contractual agreements for their care and must be accompanied by a legal
guardian, who shall assume the financial responsibility for the underage patient.
It is your responsibility to notify our office of change or loss-of-coverage with insurance, or any
change to your billing address or the address where you wish to receive our correspondence.
Any charge not paid by your insurance because of incorrect primary insurance information, failure to
submit proper insurance in a timely manner or coordination of benefits issues not handled with your
carrier will be the financial responsibility of the patient.
We are not responsible if your insurance company decides any treatment does not qualify as a
covered benefit due to deductibles, depletion of yearly funds/benefits, or any other plan provisions.
These factors are determined by the insurance company and the particular plan you (or your group)
selected.
You understand that the treatment recommended by our office is never based on what your insurance
will pay. Rather, treatment is determined by the health and needs of each patient and his/her
condition.

Appointment Policies:
Initial Consultations and Visits
Initial consultations/exams/visits and X-Rays are not complementary services.
They are a billable service, and these services may not be covered 100% by any insurance options
that may be available to you. This means there could be an out-of-pocket expense at the conclusion of
your initial visit.

Surgery Visits and Biopsy Visits
Payment is due at the time of surgery. This payment is reflective of the full cost of treatment and/or
your portion of the fees (the copay) for those with insurance coverage for the procedure).
Biopsy appointments are usually not covered by any dental insurance plans, so patients should expect
to see a fee from our office ($675) due at the time of the biopsy. Biopsies will also result in a separate
bill/ service-fee from the lab or pathologist that examines the specimen under the microscope. That
lab fee is usually (but not always) covered by medical insurance, partially or fully. Our office is not
responsible for any fees billed to you for services rendered by the lab or pathologist.

Missed Appointments and Late Cancellations/Rescheduling Fees:
A Missed Appointment (or Late Cancellation) is defined as either; not appearing for an appointment at
all, arriving more than 20 minutes late for an appointment, or not formally cancelling the
appointment [by phone or via the cancellation form] within 24 hours of their scheduled appointment.
If a patient arrives 20 minutes or later for their scheduled appointment, the visit will need to be
rescheduled, and will be considered a missed appointment and subject to a missed appointment fee
(see below).
A $150 fee will be charged missed appointments and late cancellations for initial consults, office
visits, or re-evaluations.
The fee for any missed surgery appointments or those not canceled within 24 hours of the surgery
appointment time is $750.
This $750 fee is irrespective of any estimated costs of the surgery, even if that estimate cost of
surgery happens to be lower than the missed/late fee itself.
Fees for missed appointments and late cancellations/rescheduled visits will not be submitted for
insurance reimbursement, and the patient (or guardian) is solely responsible for the cost.

Payment Plans & Options:
We accept cash, check, debit, credit, as well as payments made through 3rd party providers such as
Care Credit or Lending Club.
All credit card payments and Venmo transactions will incur a 4% surcharge; this does not apply to
cash, debit card, or checks.

Service Fees, Counsel Fees, and Costs of Collection:
Any balances left on your account over 90 days after your insurance company has satisfied all claims
will incur a 1.5% service charge every month (18% per year) until the balance is paid in full.
If your account is outstanding for more than 90 days, it will be considered delinquent, and may be
sent to, processed, and managed by a collection agency or attorney for collection. In such case, you
agree to be responsible to pay all additional collection fees, counsel fees, court fees or associated
costs. Collection fees will be at least equal to 35% of the amount of your outstanding balance, inclusive of
interest. Interest will continue to accrue on your outstanding balance until your account is paid in full.
Once your account is sent to collections, we are not able waive any fees or penalties associated with
your account. For questions regarding an account in collections, you must call Mr. John Youderian, Esq (856)-376-3702.

Insufficient Funds with Checks (Returned/”bounced” checks): A $50.00 fee will be applied for any
returned checks.

Permission to Submit Insurance Claims on Your Behalf:
OMA of Montclair will require your permission to submit any and all insurance claims on your behalf
by either postal service or electronically. You also grant permission for OMA of Montclair to submit
any letters or disputes to the insurance commissioner’s office, in an effort to collect maximum
payment from my insurance companies for services rendered by Dr. William Ranucci or Dr. Emil
Cappetta.

Phone: 973.746.3466          Fax: 973.783.4157           email: omaofmontclair@gmail.com

Address: 54 Plymouth Street     Montclair, NJ        07042