If we only provide Endodontic Evaluation (Limited Evaluation, Consultation):
This consists of an examination and testing, discussing the likelihood of maintaining the tooth and treatment options available to you. Payment is due at the time of service. As a courtesy, we will bill your insurance for you.
If we provide Treatment:
Those without dental insurance:
Payment is due at the time service is initiated. If you require payment options, please contact an Eastlake Endodontics representative.
Those with dental insurance:
Unless prior arrangements have been made, your portion of the treatment fee will be due at your first treatment visit. Dental insurance plans payment schedules vary from policy to policy. Your individual plan is an agreement between you and your employer. It is your responsibility to understand the benefits and limitations of your policy. We will provide our best estimate of the portion your insurance is going to pay. Since this varies for each individual, usually 20 – 75% of the cost of the procedure is required at the time of service. We will bill your insurance for you, however, this is a courtesy and we are under no contractual obligation to do so. Please keep in mind, however, insurance companies routinely indicate that coverage verification does not guarantee payment. If your insurance policy fails to pay their estimated portion, you are responsible to pay for the unresolved balance.
For teeth with poor prognosis:
Occasionally, the situation arises where a tooth is not expected to have a favorable outcome and treatment is terminated prior to completion. Examples included teeth with hopeless cracks, persistent infections, and irreversible structural damage as the result of prior treatment. In these cases, the treatment fee will be reduced to one-half of the pre-treatment estimate. Many insurances will not pay for partial treatment. In the case of partial treatment, we will bill your insurance in your behalf, but you will be responsible for all remaining balances not reimbursed by your insurance company.
>>>If your insurance pays more than the estimated amount, a refund check from this office will be mailed within 1 month from the date payment is received.
>>> If your insurance pays less than the estimated amount, you will receive a statement from this office. We usually do not send monthly statements so prompt attention is greatly appreciated! NOTE: If your insurance company does not reimburse us after 2 submissions, you will be responsible for the remainder of the balance since we were unable to collect from them.
If this is a dental emergency treatment visit the following applies (unless other arrangements have been made in advance):
Dental emergencies commonly require two appointments. The goal of the first visit is to provide pain relief. At the second visit (after the pain has resolved), the root canal procedure is completed.
In most cases, Eastlake Endodontics does not charge an additional emergency fee, however:
For those with dental insurance: your entire copay will be due at the emergency visit. If you do not return to complete treatment, this copay will be applied towards an incomplete treatment fee (one-half of the estimated total treatment fee). Please understand that many insurance plans will not pay for incomplete treatment, so the balance will be your direct responsibility. In nearly all cases, it is to your advantage to return to complete treatment.
For those without dental insurance: Payment is due at the time service is initiated. If you require payment options, please contact an Eastlake Endodontics representative.
Appointment cancellation and no-show policy: At Eastlake Endodontics, the appointment you make is a time (usually 1-2 hours) reserved specifically for you to treat your pre-existing tooth problem. If you find that you cannot attend a scheduled appointment, please call our office at least 1 business day in advance. This courtesy allows treatment times to be made available to other patients. If notice is not received, your account may be charged a $75 failed appointment fee. This fee is not paid for by insurance, and unless arrangements are made, will be your financial responsibility.
If your condition is such that multiple visits are necessary and you do not return for completion, you will be responsible for one half of the entire pre-treatment estimate. WE WILL NOT BILL YOUR INSURANCE. If this balance is not paid within thirty (30) days, your account will be closed and will be subject to the terms in the “Deliquent Accounts” section.
It is your responsibility to pay for dental services rendered by Eastlake Endodontics.
Eastlake Endodontics will make every reasonable attempt to collect fees. We work closely with local law enforcement, collection, and credit agencies should the situation require it.
TERMS: Net 30 days from the date of the invoice/statement date unless otherwise indicated above. A finance charge of 1.5% per month (annual percentage rate 18%) of the unpaid balance will be added monthly.
Accounts sent to a collection agency or law firm will be charged an additional 33.3% (% or $) of the entire balance owing. The patient is responsible for all legal, court, and collection agency fees that may result due to delinquent accounts.
Deliquent accounts with no active payments being made will be sent to our collections service if over 30 days past due.
A $20.00 fee will be charged for checks returned due to insufficient funds.