Financial agreement

Thank you for choosing North Hill Dental as your dental provider. We are committed to making your treatment successful. Please understand that payment of your bill is considered part of your treatment. We require you to read and sign the following financial policy before any treatment.

General

Regardless of any insurance status, you are responsible for the balance due on your account. You are responsible for any and all professional services rendered. This includes, but is not limited to: dental fees, surgical procedures, tests, office procedures, medications and any other services not directly provided by the dentist.

Appointment cancellation

We understand that situations arise in which you must cancel your appointment. If you must cancel, we ask that you give us 24 hours' notice. Appointments canceled with less than 24 hours' notice may be subject to a $75.00 cancellation fee per scheduled hour. Patients who don't show up for their appointment without calling to cancel will be considered a no-show, which is also subject to a $75.00 fee per scheduled hour.

Insurance

Your insurance policy is a contract between you and your insurance company. We are not party to that contract. As a courtesy, our office will bill the insurance company you have provided, including pre-treatment estimates sent at your request. We can't track every detail of every insurance plan, so please contact your insurance company to confirm what benefits your employer has purchased for you. If you have questions about a pre-treatment estimate or fees for service, please have them answered before treatment to avoid confusion.

Some or all of the services provided may not be covered by your insurance policy. Any balance is your responsibility, whether or not your insurance company pays any portion.

Payment

Full payment is due at the time of service. If insurance benefits apply, estimated patient copayments and deductibles are due at the time of service, unless other arrangements are made. Patients without insurance receive a 5% discount when paying with cash or check only. Payments made with a credit or debit card may be subject to a 5% service fee.

Unpaid balances over 120 days old are subject to a monthly interest rate of 1%. If payment is delinquent, the patient is responsible for the cost of collection.