Root Dental Financial Policy Agreement
Insurance Assignment
As a courtesy, Root Dental will file claims with your dental insurance carrier. You are responsible for providing accurate and complete insurance information. Any balance not covered by insurance is your responsibility and is due within 30 days of the insurance payment or denial.
Patient Responsibility
Co-payments, deductibles, and non-covered services are due at the time of service. We will provide an estimate of your out-of-pocket costs before treatment; however, final amounts depend on insurance processing and may vary.
Payment Plans
Payment plans are available for balances over $200. A minimum monthly payment will be established based on the total balance. Accounts must remain current; failure to make scheduled payments may result in the full balance becoming immediately due.
Collection Policy
Accounts outstanding beyond 90 days may be referred to a collection agency. You will be responsible for all collection costs, including attorney fees, if applicable. A $35 fee applies to all returned checks.
Cancellation Policy
We require 24 hours notice for cancellations. A $50 fee may be charged for missed appointments or late cancellations. This fee cannot be billed to insurance.
Online Billing & QuickBooks Integration
Root Dental uses QuickBooks-integrated billing software to manage invoices and payments. By using our online payment portal, you consent to electronic billing and agree that electronic invoices satisfy any requirement for written notice of amounts due.
Billing FAQ
Acknowledge & Sign
By signing below, you confirm that you have read and agree to the Root Dental Financial Policy.