Typically, endodontic treatment varies in cost from $1100 -1500 dollars. Our office will contact your insurance provider and patients are responsible for their portion on the day of treatment. Patients who are “self-pay,” those without dental insurance, can receive a 5% discount on treatment fee when paid in full on the day of service by cash, check, or debit card with PIN.

*Our office accepts credit cards (Visa, MC, and Discover) along with cash and checks.

*We also accept CareCredit™

Thank you for selecting Northeastern Endodontic Specialists for your endodontic treatment. Our goal is to provide you with outstanding dental care. For this reason, we want to provide you a thorough understanding of our financial policy.

If a patient does not have dental insurance, payment in full is due at the time of consultation or treatment. When scheduling we will supply you with an estimated cost.

The following is a copy of the consent you will sign before Consultation or Treatment in our office:

I understand, as a patient without dental insurance, my payment for consultation and/ or treatment is due in full on the day of consultation or treatment rendered.

If a patient has dental insurance:

I understand that my dental insurance will only pay a portion of the cost of my treatment and that my portion is due no later than the time of treatment (we reference this a patient co-payment).

The amount that the insurance company states they will pay is only an estimate.

If the insurance company pays a lesser amount, or denies my claim, I will receive a statement to that effect, and it is my responsibility to pay the difference. If they pay more than expected, I will be issued a refund in the same form of payment made to Northeastern Endodontic Specialists. If you paid by cash, your refund will be in the form of a check.

If the insurance company does not make payment within 45 days of claim submission, I will assume immediate responsibility for the payment and deal with the insurance company myself.

Cash                          Check                          Visa                          CareCredit                          MasterCard                          Discover                          Amex

On the day of service, I will provide a debit/credit card on file for any credit or remaining account balance after the insurance company makes payment. By signing this policy, Northeastern Endodontic Specialists has the right to charge my credit card for services rendered.

The practice will make reasonable attempts to notify you prior to charging your credit card on file but the practice shall have the right to make such charges for services you received and agreed to be financially responsible for, regardless of whether you provide confirmation to the office’s attempts to contact you prior to making such charges.

You will be charged a 2.3% service charge for all payments made by credit card.

Charges for services not paid by you within 30 days of invoice will have a service charge of 1.5% per month (Annual rate of 18%) added to the past due balance on each monthly statement thereafter.

You may be charged a cancellation fee of fifty dollars ($50.00) for any appointment cancelled by you less than twenty-four hours prior to the appointment and you may be charged a fee of fifty dollars ($50.00) if you miss a scheduled appointment. In the event of non-payment for our services after 60 days from invoice, I understand that collection agency fees, including attorney fees, if applicable, will be applied to the outstanding balance.

By signing and acknowledging this form, you hereby agree to the following:

I accept financial responsibility for any/all procedures performed by the practice, its doctors and staff.

I accept responsibility for payment of all treatment provided to me regardless of insurance coverage.

I accept responsibility for payment for all treatment for minors for which I am the parent and/or legal guardian.

I hereby provide consent and approval for the office to charge my credit card on file for any treatment received by me and/or any minor for which I am the parent or legal guardian.

This financial consent will be reviewed and signed at check-in.

Other financial notes for your review:

Consultation only:

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. Full payment is due at your scheduled consultation time for all patients. Insurance does not always pay for consultations, so we can submit charges and have the insurance company reimburse you. Consultation costs range from approximately $150.00- $350.00. Additional charges may apply

If we provide Treatment:

Those without dental insurance: Full Payment is due at time of service. There is a 5% discount for paying in full for treatment (not consultation) on day of service by cash or check. The discount does not apply to credit cards or Care Credit. If you wish to use financing we do accept Care Credit in our office.

Those with dental insurance: All copays are due at the time of service. As a professional courtesy to our patients, we reach out to insurance companies to verify dental coverage and obtain coverage percentages. As stated previously, the amount that the insurance company states they will pay is only an estimate; insurance companies routinely indicate that coverage verification is not an exact guarantee of payment.