Healthy Smile Program

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 provide tax. The Minnesota provider tax will be added to each applicable fee.

Adult Healthy Smile Program
$$350
Calendar Year
Two (2) Dental Exams
Two (2) Routine Cleanings (Code 1110)
Two (2) Flouride Varnish Treatments
One (1) set of bitewing x-rays as recommended by Birch Lake Dental
One (1) Emergency Exam with a single periapical radiographic image
Get Started
Adult Periodontal Healthy Smile Program
$$500
Calendar Year
Two (2) Dental Exams
Two (2) Periodontal Cleanings (Code 4910)
Two (2) Flouride Varnish Treatments
One (1) set of Full-Series/Panorex as recommended by Birch Lake Dental
One (1) Emergency Exam with a single periapical radiographic image
Get Started
Youth Healthy Smile Program (<12 yrs)
$$280
Calendar Year
Two (2) Dental Exams
Two (2) Routine Cleanings (Code 1110)
Two (2) Flouride Varnish Treatments
One (1) set of bitewing x-rays as recommended by Birch Lake Dental
One (1) Emergency Exam with a single periapical radiographic image
Get Started

Healthy Smile Program Advantages

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No limitations for “pre-existing” conditions

 

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No “yearly maximums”

 

*

No “deductibles”

 

*

No claim forms

 

*

No need to obtain “pre-authorization”

 

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No “waiting period”

 

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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, Veneers & Extractions

Dentals & Partials

Implants (Restorative)

Root Canal Treatment

Additional Routine or Periodontal Cleanings (>2)

Scaling & Root Planing (Periodontal Treatment)

Invisalign (TM)

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 to a specialist

Services/Treatments that are already discounted

CT Scans

Botox & Derma Fillers

Implant Placement

Electric Toothbrushes

Prescription Toothpastes

Whitening Products

Zoom! (TM) Whitening

Program Terms

· The Healthy Smile Program runs on a calendar year schedule Janruary 1 –December 31 of the current year.

· 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 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 calendar year).

· 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.

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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 planing, additional treatment(s) such as scaling and root planing 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 and refund to you the program price. 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.

Want to know more?

Our support staff is ready to assist you with your enquiry.

Healthy Smile Program Application Form
Contact us