|
office policies
Appointments
Your scheduled appointment is reserved specifically for your child. A change in your appointment affects all of our patients. If a cancellation is unavoidable, please call the office at least 24 hours in advance so that we may give that time to another patient. If 2 missed/cancelled appointments occur without 24-hour notice, our office reserves the right to charge a cancellation fee prior to scheduling a subsequent appointment.
Please plan to arrive 5 minutes or more before your scheduled appointment. This will allow time to complete any additional paperwork and see your child on time.
A parent or legal guardian (with official documentation) must be present in the office during the initial examination and any subsequent treatment appointments.
Insurance & Payment
Our office is committed to helping you maximize your insurance benefits. Because insurance policies vary greatly, we can only estimate your coverage in good faith but cannot guarantee coverage due to the complexities of insurance contracts. Your estimated patient portion must be paid at the time of service. We will accept cash, personal checks, MasterCard, or Visa. As assistance to our patients, we will bill insurance companies for services and allow them 45 days to render payment. After 60 days, you are responsible for the entire balance, paid-in-full. If you have any questions, our courteous staff is always available to answer them.
For families that do not have dental insurance, we offer a discount on your restorative treatment plan.
CareCredit
As a service to our patients, we are pleased to offer the CareCredit card, North America's leading patient payment program. CareCredit offers a full range of payment plans to meet every financing need. You can apply now online through the CareCredit website or see our staff for more details when you are in our office.
HIPPA INFORMATION
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
PLEASE REVIEW IT CAREFULLY.
THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
Our Legal Duty
We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in the Notice while it is in effect. This Notice takes effect August 1, 2009 and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of the Notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this Notice and make the Notice available upon request.
Uses and Disclosure of Health Information
We use and disclose health information about you for treatment, payment, and health care operations. For example:
Treatment: We may use or disclose your health information to another health care provider providing treatment to you.
Payment: We may use and disclose your health information to obtain payment for services we provide to you.
Health care Operations: We may use and disclose your health information in connection with our health care operations. Health care operations include quality assessment and improved activities, reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.
Your authorization: In addition to our use of your health information for treatment, payment or health care operation, you may give us written authorization to use your health information or to disclose it. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason expect those described in the Notice.
To your Family and Friends: We must disclose health information to you, as described in the Patient Rights section of this Notice. We may disclose your health information to a family member, friend, or other person to the extent necessary to help with your health care or with payment for your health care, but only if you agree that we may do so.
Persons Involved in Care: We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses and disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly related to the person’s involvement with your health care We will also use our professional judgment and our experience with common practice to make reasonable assumptions of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information.
Marketing Health Related Services: We will not use your health information for marketing communications without your written permission.
Required by Law: We may use or disclose your health information when we are required to do so by law.
Adobe PDF version avaiable for download:
back to top
|
