Office Policies

Financial Policy:

When reviewing the financial agreement (patient contract), please note that monthly payments are due once a month on the assigned day regardless if the patient is seen on that particular day or in that particular month.  A monthly payment is simply a convenient way to spread out the cost of orthodontic treatment and is not related to treatment progress or appointments; therefore, payment is still due even if there is no appointment during the month. The balance of the total treatment fee is due before the appliances are removed.

If payment is 30 days delinquent, a 30 day letter will be sent. During this month the patient will be seen but no active treatment will be performed. We will check for broken or loose appliances and evaluate hygiene until the account is brought current.

If the account falls 60 days delinquent, no active treatment will occur until the account is brought up to date.

If the account falls 90 days delinquent, a DISMISSAL letter will be sent by certified mail. This will terminate our responsibility to the patient. Further orthodontic treatment will have to be rendered by another orthodontist.

Insurance Policy:

Upon verification and assignment of orthodontic insurance benefit, an insurance ledger will be established with the amount of estimated insurance benefits. Our office will then be responsible for the monthly/quarterly filing of insurance statements.

Insurance will pay provided the patient is still eligible for coverage, active treatment is still being rendered and the lifetime orthodontic benefit has not been exceeded.

If for any reason during active treatment the insurance benefits decrease, change or terminate, the unpaid balance will be transferred back into the patient’s ledger and will be the responsibility of the patient. Any unpaid insurance balance at the end of treatment is the patient’s responsibility and must be paid before appliances are scheduled to be removed.

It is the patient’s/parent’s responsibility to inform us of any change in coverage or company. We may need to ask your help in filling out forms or making calls to the insurance company.

We reserve the right to refuse to process/accept insurance benefits at any time.

Treatment Cooperation Policy:

Successful treatment is dependent on the following:

*Patient cooperation in elastic wear                                   *Proper oral hygiene

*Reporting broken or lost appliances promptly              *Proper care of appliances (no breakages)

*Eating the proper foods that will not cause breakages or cavities

*Keeping appointments as scheduled (broken appointments interrupts and extends treatment progress)

Extra Charge Policy:

     No-Show, Same Day Cancellation, or Same Day Re-Scheduling:

Please remember that we set aside time just for you, so please make every effort to keep your appointments and arrive on time.  If you are not able to make your appointment, we must be notified at least 24 business hours in advance (Monday-Thursday / 8am-4pm) to cancel or re-schedule for any reason .  If you have a Monday appointment, we must be notified the Thursday before your appointment before we close at 4pm.  This policy applies to initial appointments (records & braces), adjustments, emergencies, and retainer check appointments.

          The following fees will be assessed accordingly:

  • If a patient does not show up or arrives too late for their 10-30 minute scheduled appointment, a charge of $35 will be applied to their account and must be paid at their next appointment.  This applies to arriving too late for an appointment as well.  We usually give a 10 minute grace period unless it is the last appointment before our lunch break or if your appointment is at 3:50pm or after.  There are no grace periods for those appointments. 
  •  If a patient does not show up or arrives too late for their 40-180 minute scheduled appointment, a charge of $75 will be applied to their account and must be paid at their next appointment. This applies to arriving too late for an appointment as well.  We usually give a 10 minute grace period unless it is the last appointment before our lunch break or or if your appointment is at 3:50pm or after.  There are no grace periods for those appointments. 

     Orthodontic Breakages:

If a patient happens to break a bracket or a band, for any reason, the first breakage is free and then it is $55 per breakage after that. Also, if there are any other breakages, a cost will be determined at that time.

     Overage Charges:

ADDITIONAL MONTHLY CHARGES MAY BE INCURRED FOR EXTENDED TREATMENT TIME DUE TO POOR COOPERATION (i.e. lack of rubber band wear, poor tooth brushing and improper diet, and lost time due to breakages or missed appointments). Your treatment may be discontinued for lack of patient and/or parent cooperation.  Charges will be determined at the appropriate time.

     Color Changes:

Please make sure that the color you choose at your appointment is what you want for the next 4-6 weeks.  If a patient would like there color(s) changed prior to their next appointment, the cost is $10.

     Lost or Damaged Retainers:

Most financial agreements, includes one set of retainers. If you require another set because they are lost, damaged or you had restorative dental work, there will be a charge for the new retainer(s). The cost will be determined at the appropriate time.

Limited Space / Minors Policy:

Due to limited space, only the patient and two others are to accompany the patient to his or her appointments. This will be strictly enforced.  It is the policy of this office that only the patient (unless it is a consultation appointment) is allowed in the clinic area.  If a parent has to speak to Dr. Hithe or the clinic staff, they can accompany the patient to the clinic.

All patients under the age of 18 years old must be accompanied by an adult and not simply dropped off. If the adult is unable to stay for the duration of the appointment, this should be cleared by the doctor prior to leaving the office. No child or children ages 7 and under are allowed in the tooth brushing area, unless cleared by the front desk staff. Parents are responsible for all actions of their children and are financially responsible for any damage done to the facility. There is no running in any area of the building.

Appointment Policy:

Appointments are normally scheduled at four (4) to six (6) week intervals. In order to provide quality orthodontic care, it is necessary to schedule some appointments during school/work hours. Appointments an hour or longer will be scheduled in the morning. We understand that this can be inconvenient for some patients. However, it is important to schedule lengthier appointments during school/work hours to achieve the best possible treatment.

It is up to the patient to schedule his/her own appointments on a timely basis. These can be scheduled when leaving after each visit and are therefore scheduled in advance. Twenty-four (24) hour notice is required to cancel an appointment. If an appointment is missed, it is the patient’s responsibility to contact our office immediately to set up a new appointment.

As a courtesy to you, our office will confirm your appointment 1 day prior to your appointment (unless it is a Monday appointment). Please do not rely on this as the only means of remembering your appointment as there could be circumstances that may prevent a call from going out. We offer this only as a courtesy to you. We can also email a reminder to you the day before your appointment. Please provide us with your email address if you would like to take advantage of this method.

Cell Phone Policy:

As a courtesy to others, cellular phones should be turned to “off,” “vibrate,” or “silent” while in the Lobby, Clinic, or any other area of the building.  If you need to take a call, please step outside of the building.  Cell phone use while being treated is strictly prohibited.  Dr. Hithe and her staff take pride in giving their full attention to their patients and cell phones can be very distracting.

Hygiene / Color Change Policy:

Properly brushing your teeth is a MUST.  If proper oral hygiene is not maintained, permanent marks and scarring of the teeth can result.  Also, if a patient presents with poor oral hygiene at his/her appointment, we reserve the right to refuse the option of letting the patient pick a color of his or her choice for that visit.  We will put the color grey (that matches the braces) and not any other color.  If the patient presents with fair, good, or excellent hygiene, then he/she can pick the color (s) of their choice.  This assures that our patients understand the importance of oral hygiene while in treatment with Dr. Hithe and for the rest of his/her life. 

General dental care and checkups are the responsibility of the patient/parent and your regular family dentist.  We advise patients to see their general dentist every six (6) months during active orthodontic treatment. In the event that you have changed dentists or there has been a change in medical history, please notify our office as soon as possible.

Mouth Guard Policy:

The risk of serious injury to the mouth whether you have braces or not, is inherent in virtually any sport or activity that might result in trauma to the head. Therefore, it is important that you or your child wear a mouth guard while participating in any of these sports or activities. Please remember that wearing a mouth guard of any kind cannot completely prevent injuries from occurring.  Hithe Orthodontics provides one free mouth guard upon request.

Saturday Appointment Policy (If Applicable):

Saturday appointments will be reserved for initial placement of braces and those directly approved by Dr. Hithe (i.e. out of state college students {valid student ID will be required as proof}). Saturdays are available one Saturday a month only during the school year and not during major holiday months or summer time. Also, accounts must stay current in order to be considered for a Saturday appointment. If a Saturday appointment is canceled (even with sufficient notice) or missed for any reason, a future Saturday appointment will not be offered to that patient.