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G.Nili, D.M.D. Newport Beach
Creating Beautiful Smiles
Call: (949) 719-1430

Forms-Insurance policy

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival. Thank you and please call our office if you have any questions at all.

Patient Forms (Print & Complete All Forms Prior To First Office Visit)

Insurance office Policy

Indemnity insurance is accepted; we ask that you pay your estimated portion of your bill at the time of service.  We gladly assist you with insurance billing and ask that you bring a completed insurance form and/or your carrier's card with you to expedite the billing process.  We are proud of the fact that the practice is entirely "fee-for-service" and private indemnity.  This environment allows the delivery of uncompromising and superior treatment, uncontrolled by the constraints of managed care.

Insurance Policy and Guidelines

How does dental insurance work?

There are many different agreements between insurance carriers and their subscribers; each contract provides a different benefit. However, dental insurance greatly differs from medical insurance in that each insured individual usually has a maximum benefit per calendar year.  This benefit is paid as a percentage of the fee until the benefit maximum has been met.

How does our office assist you with insurance?

For your convenience, we will gladly assist you in submitting initial insurance claims pertaining to charges for care rendered in our office.  However, please be aware that our primary financial relationship is with our patients or their families and not with their respective insurance companies.  Financial arrangements can be made based on your estimated insurance benefit, however, any outstanding insurance claims not paid are the responsibility of the patient or the patient's family.

Helpful Hints

  • Know what your benefits are before treatment starts.  If you are not sure, your insurance company may be contacted so that you know exactly how much you can expect to be reimbursed and when to expect payment.

  • If you would like our office to submit claim forms, we ask that you provide us with the name, address and telephone number of your insurance carrier as well as the appropriate forms.  Please complete the insured or employee portion of your form and sign where indicated.

  • We cannot render services on the assumption that our charges will be paid entirely by an insurance carrier.  However, for your convenience, we will accept payments from your insurance company assigned to us by the insured.  Such payments will be credited accordingly to your account.


Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the contact form below.
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