Insurance and Required Forms

Insurance

Below is the insurance accepted by the providers and clinic :

  • ​C. Whitney Yeates, D.D.S.
  • Clinic (OUCP Dental Residents)
  • Delta Dental
  • Metlife Dental
  • Soonercare

*OUCP Family Dentistry is always accepting new patients!

Required Forms

Thank you for choosing OUCP Family Dentistry. We strive to make your experience with us as enjoyable as possible.

For all first time patients and returning (after 6 months or more), we have put our Patient Forms on our website. You can click on any of the forms to examine them. If you would like, you can print these and fill them out at home, so you won’t have to arrive as early to your first dental appointment.

Things you need to bring with you to your first visit:

  • Patient Registration Forms (English or Spanish)
  • Dental Insurance Card
  • Photo Identification Card
  • Any legal guardianship documentation

Please click on the link below to view, examine and if you choose, print our forms:

Helpful Documents

Financial Policy

Please click on either link below to view and sign these forms:

Financial Policy Brief

Soonercare:

  • Child (under 21 years) Please make sure your Soonercare I.D. number is active. We will accept Soonercare as payment in full. If not active, you will be considered SELF-PAY and be held responsible for payment.
  • Adult (over 21 years) Medicaid ONLY pays for emergency tooth extractions. Medicaid will NOT cover cleanings, fillings, etc. you will be considered SELF-PAY and be held responsible for payment.

Self-Pay

You will be responsible for payment on or before day services are rendered.

Commercial Dental Insurance

Please bring your insurance card with you to all appointments. As a courtesy to our patients, we will file your insurance and also accept insurance payments. You are responsible for any co-payments and/or deductibles the day treatment is provided. Also, please notify our office if you have any secondary insurance coverage.

If the dentist/clinic is not a “contracted provider” with your insurance company and/or your insurance does not accept assignment of benefits, payment in full will be due on or before the day treatment is provided. We will file your insurance for you and you will be reimbursed directly by your insurance carrier.

Insurance coverage is ESTIMATED – your actual indemnity may be less. You, the patient are responsible for all amounts not covered by your insurance carrier. Year-to-date used benefits and remaining deductible amounts are not affected until the procedure is completed and therefore are not used in this determination of benefits.

Out-Patient Surgery

If in the event your child is given a surgery date for dental restoration, your estimated co-payment and or deductible is due on your child’s pre-admission appointment day.

Payment Options

  • Cash
  • Check
  • Credit Card (Visa & Mastercard)

You are responsible for any amount not covered by your insurance.

The above policy applies only to the dental treatment rendered.

Hospital and Dental services are billed separately.

All account balances over 90 days past due will be turned over to collection services.