Fees and Financial Responsibility Policy
We make every effort to keep down the costs of your treatment while providing you with the highest level of professional care. An estimate of your treatment will be provided to you. Our treatment plans are estimates only and your portion of payment may change from the time of such estimate.
Appointment Deposit – In order to reserve an appointment on our schedule, we require a $75.00 deposit at scheduling which will be credited towards payment for your procedure. This deposit is fully refundable with 24 hours’ notice. Please note that if your appointment is on a Monday or the day after a holiday, we will require one full business days’ notice.
For your convenience, we offer the following payment options: Cash, Visa, MasterCard, Discover, American Express, Care Credit and Health Savings Account (checks are no longer accepted).
As a courtesy, we will submit your insurance claim for you. However, the patient/guarantor is, and remains, responsible for all remaining balance that is not paid by their insurance benefits 30 days from the date of service.
When signing our Financial Responsibility Policy, you are agreeing to the following:
- You are financially responsible for your dental/health insurance deductible, coinsurance, or non-covered service.
- Co-payments are due at time of service.
- If your plan requires a referral, you will obtain it prior to your visit.
- If, in the event, that your dental/health plan determines a service to be “not payable”, you will be responsible for the complete charge and will agree to pay for the costs of all services provided together with any recovery fees in the event of non-payment. If you are uninsured, you will agree to pay for the dental/medical services rendered to you at the time of service.
At North Penn Endodontics, we make every effort not only to provide you with the finest dental care, but to work hand in hand with you to maximize your insurance coverage for your covered procedures. Our team is well-informed, up-to-date, and here to help answer any questions you may have regarding your coverage.