Birch Lake Dental’s
Healthy Smile Program
We created an in office program for those who do
not have insurance! Our Healthy Smile Program
provides you with routine preventative dental care
and discounts on many dental treatments for one
low annual fee!
TERMS & CONDITIONS
*The annual fee does not include applicable Minnesota provider tax.
The Minnesota provider tax will be added to each applicable fee.
Birch Lake Dental’s
Healthy Smile Program
We created an in office program for those who do not have insurance! Our Healthy Smile Program provides you with routine preventative dental care and discounts on many dental treatments for one low annual fee!
TERMS & CONDITIONS
*The annual fee does not include applicable Minnesota provider tax. The Minnesota provider tax will be added to each applicable fee.
Healthy Smile Program Advantages
*
No limitations for “pre-existing” conditions
*
No “yearly maximums”
*
No “deductibles”
*
No claim forms
*
No need to obtain “pre-authorization”
*
No “waiting period”
*
No “membership card” required
Discount on other services:
15% discount applies to basic and restorative treatments, including the following:
Composite fillings (tooth-colored)
All Crowns
Extractions
Veneers
Dentures & Partials
Implants
Root Canal Treatment
Additional Routine or Periodontal cleanings, (more than the two (2) included in the Program)
Scaling and Root planning (Periodontal treatment)
Occlusal splints/NTI
Nitrous Oxide
Plan Exclusions
All treatments and services not performed at Birch Lake Dental, as well as the products listed below, are not eligible for discount:
Any dental treatment referred out of the office
Services/treatments that are already discounted
Botox and Derma fillers
Electric toothbrushes, Prescription tooth pastes, and Whitening products
Zoom! TM whitening
Invisalign
Program Terms
· The Healthy Smile Program runs on a calendar-year January 1st to December 31 st .
· Fees are non-refundable, non-transferable, and cannot be applied to a future date or service, even if the
participant does not utilize the program at all during the calendar year of the program participation period.
· Fees must be paid in full at the beginning of the program period via cash, check or credit card to be eligible for
included and discounted treatment.
· Discounted treatment is not eligible over other existing discounts (e.g., cash or check discount, promotions etc.).
· To receive discounts on treatment, the participant patient must remain enrolled in the Healthy Smile Program
throughout the course of treatment (even if treatment extends beyond the initial 12 months).
· The Healthy Smile Program cannot be applied retroactively to dental treatment received prior to participation.
· Included treatments/discounts cannot be transferred between family members.
· Minnesota care provider tax will be added to all treatment, whether or not eligible for discount.
· This program does not require a membership card, ID number, or group number. All program information is
kept in electronic format on the Birch Lake Dental system.
· Annual program fees and treatment costs are subject to change without notice.
Program Conditions, Limitations and Disclosures
· This program is not available to persons who have dental insurance or a dental benefit plan.
· If you have been diagnosed with Periodontal Disease (defined for this purpose as having 4 millimeter or greater pocket depths) you will be enrolled in the Adult Periodontal Healthy Smile category since a “routine” cleaning will not be sufficient for your oral health care needs. If you have been diagnosed with Periodontal Disease and have not had scaling and root planning, additional treatment(s) such as scaling and root planning may be required that are not covered in the Healthy Smile Program, but will qualify for the 15% discount.
· If you refuse to follow the dentist’s treatment recommendations for care that is consistent with the standard of care, and necessary to ensure your oral health, even if the treatment recommendations are not included within the Healthy Smile Program, then Birch Lake reserves the right to cancel your enrollment in the program. However, Birch Lake Dental expressly reserves the right to offset the amount of fees at its filed fee amounts for the care that it has already been provided to you against the amount of the program price to be refunded.
· All dental treatments in the Healthy Smile Program, and those eligible for discount are provided by Birch Lake Dental only.
· The Healthy Smile Program offered by Birch Lake Dental is not dental insurance, a dental benefit plan, health insurance, or a health benefit plan.
· This program is unrelated to, and does not meet, the minimum creditable coverage requirements under any law and is not intended to be a Qualified Health Plan under the Affordable Care Act.
· The Healthy Smile Program is offered as a way to make dental care more accessible. This program cannot be used:
o In conjunction with any other discounts, dental or health plan, or dental or health insurance.
o In treatment plans addressing any injury covered by workers’ compensation insurance, auto insurance, disability insurance, medical insurance, or where the treatment is involved, in any way, with a civil or criminal legal proceeding.
o Combined with any other offer from Birch Lake Dental.
o For treatment that, in Birch Lake Dental professional’s opinion, requires referral to a specialist, and treatment provided by any specialist to whom you have been referred by Birch Lake Dental.
o For treatment with any dentist or specialist outside of Birch Lake Dental.
Appointments
We take pride in spending quality time with each patient. When you make an appointment with us, it is time specifically reserved for you. If you need to change or cancel an appointment, we require that you give at least 24 hours’ notice.
If you must change your appointment, we require at least 24 hours’ notice to avoid a minimum $100.00/hour cancellation fee.
Want to know more?
Our support staff is ready to assist you with your enquiry.
Healthy Smile Program Application Form