The fee for Endodontic treatment is determined by the complexity of the treatment. This will be determined at the time of consultation and discussed with you prior to any treatment initiation. If additional treatment changes are necessary upon treatment initiation due to unexpected findings, additional cost or remissions will be discussed & the appropriate changes will be done to reflect those changes in your financial plan for the treatment.
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.
If we provide Treatment:
Those without dental insurance: Fifty percent of the total will be required when we begin treatment and the balance due upon completion of treatment. If we complete treatment in a single visit, payment is due at the time of service.
Those with dental insurance: While dental insurance plans offer financial assistance, they rarely cover the entire fee. We encourage patients to become familiar with their dental plan benefits including yearly maximums, deductible, if any, and in-network/out-of-network benefits. Please do not hesitate to ask should you have any questions regarding how we handle your dental plan benefits in our endodontic office in San Jose or Fremont.
We will estimate the portion that your insurance is going to pay. This will vary from patient to patient, depending upon which dental plan the patient has. Please keep in mind however; insurance companies routinely indicate that coverage verification does not guarantee payment. A treatment estimate will be provided to you during your consultation appointment. It’s just an estimate & it does not guarantee insurance payment due to other variables which we do not a have an access to during your insurance verification process. As a courtesy,we will bill your insurance for you. Most insurance companies will respond within four to six weeks.
- If your insurance pays MORE than the estimated amount, a refund check from our office will be mailed within 1 month from the date payment is received from the insurance company.
- If your insurance pays LESS than the estimated amount, you will receive a statement from this office.
- 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 payments are not received promptly, we reserve the right to report non-payment to the credit bureau and/or submit to collections. You will be responsible for any additional fees that are incurred due to this process.
- If payment is made with a check and the check is returned for any reason, a fee of $50.00 will be added to the balance owed.
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For your convenience, we accept major credit cards (MasterCard or Visa) as well as participate in a payment plan called “Care Credit”. For more information regarding Care Credit, visit www.carecredit.com.
As a service to our patients, our practice accepts many dental insurance programs, including non-managed care, indemnity (traditional), and PPO out-of-network. We are not part of any managed care network. Our staff will prepare all the necessary forms for your dental benefits. However, we remind you that your specific policy is an agreement between you and your insurance company. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. Our staff will gladly submit a pre-treatment estimate to your insurance company so that you will know what your benefits will be.
The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. You should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly, while others delay payment for several months.
Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage.
Dental insurance is one of the most beneficial and most misunderstood factors in dental treatment today. Dental insurance is provided through a contract between your employer and a dental insurance company. The terms of your coverage are negotiated between these two organizations, and your specific policy is based entirely on their agreements.
Endodontic offices are NOT involved in determining which dental services are included, the percentage of fees covered, or whether a specific service is covered at all. Not all dental treatments are covered by all dental insurances. Some endodontic services are completely excluded. Our intent is to provide you with the highest quality of care, but your dental insurance may cover only very basic services catering to their financial incentives. This is the KEY difference between the objectives of healthcare providers & insurance companies. Our goal is to suggest what the best treatment for your specific needs is and NOT based on what your insurance may or may not cover. The specific services covered are based on the cost of the insurance policy to your employer and the amount the insurance company is willing to pay.
Dental Insurance for EndodonticsAlthough endodontics offers superior treatment results, dental insurance places a limit on how much it will pay toward the endodontic fee. Because insurance companies have an annual maximum benefit, coverage of your root canal therapy will be covered according to your specific plan, and only up to your annual maximum. Once your annual maximum has been reached, the insurance company will not provide additional benefits for any dental service until the renewal period.
We accept many insurance plans, and please call our office to verify if we currently accept your specific insurance. If your company is not contracted with us, we are considered out of network, and we work to get an estimate from them, based on your benefits, for your estimated co-pay. Sometimes there is not much of a difference between in-network and out-of-network fee schedules. In any case, your referring office sent you here because they knew you would get the best endodontic care there is, so we are willing to help with payment options for your co-pay.
Fees and Co-Payments
Each endodontic case is different, and fees vary accordingly. Once an examination and consultation are completed, we will be able to tell you the fee and give you an estimate of how much your dental insurance will cover. Because dental insurance covers only part of the root canal fee, each patient is responsible for paying the remaining balance. This co-payment is the responsibility of each patient and is due when the endodontic treatment is completed. We offer alternate financial options such as CareCredit (www.carecredit.com), so you can opt to use this 3rd party credit option if you choose it. You will be applying for credit directly with CareCredit, and their approval process is fairly simple and can be applied online before making an appointment with us.
Pre-Determination PoliciesA pre-determination is a submission sent to the insurance company prior to treatment to determine how much they will pay toward your root canal. However, because our office is aware that your coverage will be limited and a pre-determination may take several weeks, we do not advise waiting for a response from your insurance company before beginning your root canal procedure.