Insurance and Payment Information

Important Information regarding your Health Insurance Coverage and Reimbursement(s) as Evergreen Dental Anesthesia does NOT accept Direct Reimbursements, nor does Evergreen Dental Anesthesia handle direct billing.

BEFORE SCHEDULING an appointment with Evergreen Dental Anesthesia, Please Consider the Following:

Evergreen Dental Anesthesia/Dr. Nathan Carillo, D.D.S. does NOT bill insurance carriers directly and you will be responsible for determining any eligibility you may have. On the day of your appointment, before being discharged from the office, you will be provided with a “Superbill”, so that you, as the insured can submit it to your insurance company

Evergreen Dental Anesthesia DOES NOT ACCEPT Medicaid, Medicare, Tricare or any Payment Based on Reimbursement from your insurance company

There is a Mandatory Deposit Required on File Before the Appointment Date, this deposit covers cost of medications, equipment, setup/breakdown of the treatment room, travel and administrative costs. At the end of the appointment, the deposit will be applied towards the final amount due before being discharged from the office. Please note, the deposit can be placed online through Evergreen Dental Anesthesia’s website under the “Deposit/Fees and Payment Information” section.

You Will Be Responsible for Payment in Full at The End of The Case Either by Cash or Credit Card, regardless of insurance eligibility.

All Anesthesia Fees Are Separate from The Dental Fees incurred during your procedure

Evergreen Dental Anesthesia Does NOT Accept Checks

The Total Anesthesia Fee is calculated On the Day of The Appointment and is determined by the dentist’s treatment time + an additional 30 minutes (15 minutes for induction of anesthesia/15 minutes for recovery of anesthesia). For every case, there is always the possibility of the dentist’s treatment time going shorter or longer than expected so the actual treatment time is always calculated on the day of your appointment. Please note, recovery will take longer than 15 minutes but the fee for anesthesia will end at this time.

Anesthesia Deposit/Fee Information

Pediatric Patients (13 years old and younger)

Pediatric Fees

1. $950 fee for every case which is 2 hours or less

2. $600/hr billed in 15 minute increments for cases 2 hours or longer

Pediatric Deposit

There is a mandatory $300 deposit in order to HOLD the appointment. A deposit is REQUIRED on file for EVERY case BEFORE the scheduled appointment date. This deposit will be applied towards the total anesthesia fee calculated at the end of your procedure.

Adult Patients (14 years old and older)

Adult Fees

1. $600 for every case which is 1 hour or less

2. $600/hr billed in 15 minute increments for cases 1 hour or longer

Adult Deposit

There is a mandatory $500 deposit in order to HOLD the appointment. A deposit is REQUIRED on file for EVERY case BEFORE the scheduled appointment date. This deposit will be applied towards the total anesthesia fee calculated at the end of your procedure.