Now that you are in receipt of your treatment plan letter, please read the following information so that you are aware of the terms and conditions for provision of Prosthodontic treatment by Dr Mandikos. If you are unsure of the meaning or have any questions of any of the information presented in the treatment plan or the below-listed terms and conditions, then please contact Dr Mandikos directly to discuss the matters before accepting the treatment plan proposed and commencing treatment.
1. Professional Fees
Prosthodontic treatment plans are frequently complex and protracted in duration and may involve complete rehabilitation and reconstruction of a patient’s dentition. Professional fees are determined on a fee per service basis (ie: per crown, implant, filling, etc.). The fee for each service is in turn calculated as a measure of the clinical time, instrument and materials costs involved in the provision of the professional service. Professional fees quoted in a written treatment plan are inclusive unless otherwise stated. Occasionally a treatment letter may make reference to approximate professional fees for the provision of services by other dental practitioners or specialists. When other practitioner’s fees are listed, the fees are estimates only to assist the patient in planning for the overall anticipated costs of treatment. Actual fees quoted in a treatment plan letter are for professional services provided by Dr Mandikos only. The fees are valid for treatment commenced within three months from the date of the treatment plan letter and are not able to be negotiated.
2. Payment
Payment for professional services may be made by cash, cheque, Eftpos, Visa or Mastercard. Acceptance of the written treatment plan indicates your acceptance and agreement to pay all professional fees in full. At the time of the first appointment for treatment, a payment of 20% of the total treatment cost must be made to confirm commitment to the treatment. Due to the inherent cost of certain dental laboratory procedures, installment payments must be made as treatment progresses with any remaining balance of payment to be made in full at the time of initial placement of the final prosthesis. This will be irrespective of any review or adjustment phases planned for a defined follow-up period. The final prosthesis will not be placed if the account outstanding is not paid in full and a fee may be charged if an appointment must be cancelled because of such an occurrence. If the total cost of treatment is over $5000 and you elect to pay the full balance before the commencement of treatment, then a 6% bookkeeping courtesy will be discounted from your account.
3. Health Insurance Cover and Rebates
If you have private health insurance with dental cover, you may be eligible for a rebate from your insurer on the cost of your dental treatment. Please note that rebate amounts are determined by your insurer and may have little relevance or correlation to the actual professional fees incurred. The association between yourself and your health insurer is yours alone and whilst our staff may attempt to help with processing of your health insurance claims, we have no association with any health insurer. Your policy with any outside insurer and its terms and conditions, and the level of rebate you receive is a matter between you and your insurer. Failure of your insurer to provide you with any anticipated or actual rebate is a matter between you and your insurer and does not constitute grounds for failure to pay your account with Dr Mandikos.
4. Tax Deductible Treatment
If the total fees for your dental treatment for a given financial year exceeds $1250, you may be able to claim a rebate on your income tax return for a percentage of that amount, less any rebate from a health insurer. You are advised to consult with your financial advisor to determine the availability of such a rebate in your particular instance.
5. Warranty on Dental Treatment
The prosthetic treatment provided is warranted for replacement at no cost should a failure occur. Failure constitutes technical and construction faults only and does not include recurrent decay due to poor patient oral hygiene; overload failure due to patient non-compliance in wearing a prescribed splint for grinding habits (if applicable); failure due to accident or injury; failure due to willful or habitual damage (eg. nail biting); failure due to a change in the patient’s perception the aesthetics of the final case after completion of treatment or failure due to loss or damage whether or not due to negligence on the patient’s behalf. Other dental professionals may be involved in the provision of services in complex treatment plans. Failure of treatments performed by other practitioners is not warranted. Denture relines and adjustments or replacement of worn, expendable, attachment components as part of a normal maintenance procedure does not constitute a failure. Should a failure occur, Dr Mandikos would replace the prosthesis or arrange provision for replacement by another practitioner at no cost to the patient. The warranty period is for 5 years from the date of initial placement of the prosthesis, and is only valid if the patient returns for six-monthly review appointments. These appointments are at half the usual examination fee to review and check the prosthesis only and are not a substitute for regular recall examination and tooth cleaning services provided by your referring or other general dentist. Whilst the warranted period extends 5 years, this does not mean that your prosthesis will not last longer if well maintained. In extreme rehabilitative or reconstructive cases, the dentition may be so compromised that even complicated, high quality prostheses may have a guarded or poor long-term prognosis. In such cases a normal warranty cannot be provided. The applicability or non-applicability of a warranty is indicated by Dr Mandikos at the end of this document.
6. Discontinuation of Treatment
Once you have commenced treatment, you agree to accept all responsibility for ensuring completion of the treatment in a timely manner. Should you elect to cease treatment, pro rata payment must be made for professional services to that point. Dr Mandikos accepts no responsibility for the state or maintenance of your oral health from that point onwards. If requested by the patient, or if treatment discontinuation results from an unavoidable geographic relocation, Dr Mandikos will endeavour to provide the name(s) of a practitioner to refer to. In circumstances where treatment is discontinued, no warranty exists on treatment.
If you have read and understood the above listed terms and conditions of treatment and agree to commence treatment as prescribed in the treatment letter, then kindly sign where indicated below and return this treatment letter to Dr Mandikos. ) Please note that the appropriate payment will be required before commencement of the initial treatment appointment)
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I hear by state that I have read and understand the terms and conditions that apply to professional treatment to be provided by Dr Mandikos. I have read and understand the treatment plan proposed in the letter and consent to being treated as outlined by Dr Mandikos and any practitioners I am referred to.
______________________ ______________________________ _________
Signed Printed Name Date
______________________ A normal warranty ____________ apply to this treatment.
Dr Michael N. Mandikos (does/does not)
