If we provide only an Endodontic Evaluation (Limited Evaluation, Consultation):

This consists of an examination, xrays, testing, and 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 applicable).

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 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.

NONCOVERED SERVICES POLICY

Dr. Richards considers it his responsibility to act in the best interest of your dental well-being, regardless of insurance plan limitations. In our efforts to achieve the best possible result, Dr. Richards may recommend supplemental services that may or may not be recognized as a covered benefit by your dental plan. These non-reimbursable services are the financial responsibility of the patient.

Some common services possibly not covered under your dental plan contract may include:

• CBCT (D0364, D0365, D0366, D0367)
• GentleWave Technology (D99993),
• Post Removal (D2955),
• Incomplete Therapy (D3332, D3999, D39995),
• Medication Changes (D99996),
• Internal Bleaching (D9974),
• Missed appointment fees (D9986).

• Care Credit is welcome as payment for out-of-network insurance and uninsured patients. At this time we cannot accept Care Credit for in-network copayments due to the significant discounts already in place.

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 prior to services being rendered.

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.

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 “Delinquent Accounts” section.

Delinquent Accounts:
It is your responsibility to pay for dental services rendered by Eastlake Endodontics.
Should a balance or credit exist on your account that is $5.00 or less, we will not pursue collecting or issue a refund. The balance/credit will be eliminated and the account considered resolved.
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 60 days from the date of the service/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. Starting with the second statement/account reminder, you will be charged a non-refundable $5 statement fee to cover administrative costs resulting from your delinquent account.
Delinquent accounts with no active payments being made will be sent to our collections service if over 30 days past due.

Accounts sent to a collection agency or law firm will be charged an additional 40% (% 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.

A $20.00 fee will be charged for checks returned due to insufficient funds.