Lakota Premier Dental Savings Plan Terms and Conditions
The following are terms and conditions of the Lakota Premier Dental Savings Plan. You are agreeing to and accepting that you understand the below terms and conditions through your submission of the Plan enrollment form. All Members subscribing to the Plan’s Membership should read this Agreement carefully and communicate any questions that may arise to: firstname.lastname@example.org
Each Member of the Savings Plan is entitled to receive dental services as described on a plan by plan basis, and at fees according to each Lakota Premier Dental Savings Plan Fee Schedule. In exchange for services rendered, members must pay the Provider directly at the time of service unless otherwise agreed upon between Provider and Member. If treatment is not paid in full at the time of service plan specific discounts are void. If paying for treatment using Care Credit or Lending Club, the discount offered on treatment will be 10%.
Current patients wishing to enroll in the Lakota Premier Dental Savings Plan must have a $0.00 ledger balance.
If a Member wishes to confirm whether a particular dental procedure is on his/her Savings Plan’s Fees Schedule, or wishes to confirm the current fee for a particular dental service, he/she should first contact the office directly for assistance at: 513-755-0801.
The Lakota Premier Dental Savings Plan will become effective on the date of enrollment. No retro-active benefits will be made available.
Effective enrollment date is a day when Membership dues were paid in full after acceptance of membership application by the Office. The Savings Plan Membership Term is based on Plan year and will run 365 days from the effective date. Full Plan dues are required on the date of enrollment. The Type of Membership must be selected at the time of submission of Application form. Type of Membership cannot be changed until end of yearly term. There are no waiting periods applied for levels of service. Savings Plan membership can be renewed at the end of each plan year.
It is the member’s obligation to make use of the services included in the agreement within their plan year limit. Unused benefits will not be carried over or reimbursed. This savings plan is non-transferrable.
The member has the right to opt out of the savings plan within 30 days of enrollment as long as no services have been rendered. If any treatment has been provided, or if beyond 30 days from enrollment, no refund will be offered.
It is the responsibility of the member to inform Lakota Premier Dental of any changes in billing information, such as expired credit cards. If we are unable to process a patient’s credit card for payment, the Lakota Premier Dental Savings Plan is void until payment is made. Any future scheduled appointments will be cancelled and will not be rescheduled until the Plan is in good standing.
This program is a dental discount membership program offered by Dr. Hassan Dawas who is Ohio’s licensed dentist. Lakota Premier Dental’s Savings Plan is not a licensed insurer, health maintenance organization, or other underwriter of health care services. No portion of any providers’ fees will be reimbursed or otherwise paid by Lakota Premier Dental’s Savings Plan. You are responsible to pay for all health care services at the time of your appointment. Plans may not include all dental procedures. Members might receive certain percentage discounted of Providers Usual and Customary Fees on dental procedures not listed on the plan fee schedule.
Accepted Applicants will receive an “Acceptance upon payment” notice within 72 business hours of submission of an application. By selecting to be a member, you are authorizing Lakota Premier Dental to bill your credit card or checking account for the membership you have selected. By submitting the application, and selecting to be a member you indicate you have read the terms and conditions of the membership.
The Office reserves the right to terminate Plan members from its plan for any reason.
Appointments broken without 24 hours cancellation notice will be subject to standard $25 cancellation fee.
If you would like to file a complaint regarding your membership, you must submit your grievance in writing to: Dr. Hassan Dawas, 7908 Cincinnati Dayton Rd. Suite B. West Chester OH. 45069.
THIS MEMBERSHIP PLAN IS NOT INSURANCE: This Savings Plan cannot be used in conjunction with Insurance Plans or other Dental Discount Plans. This Savings Plan is valid only at Lakota Premier Dental. Care from other providers and specialists is not included.
The plan member is obligated to pay for all dental services to the Provider at the time of service.
Plan fees are subject to change.