HIPAA Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
  • We will provide a copy or summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations.
  • We are not required to agree to your request, and we may say “no” if it would affect your care.
  • If you pay for a service or health care item out of pocket in full, you can ask us not to share that information for payment or operations with your insurer.
  • We will say “yes” unless a law requires us to share that information.

Get a copy of this privacy notice

  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically. We will provide you a paper copy promptly.

Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will verify that the person has authority before taking any action.

File a complaint if you feel your rights are violated

  • You can complain if you feel we have violated your rights by contacting us using the information provided.
  • You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by:
    • Sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201
    • Calling 1-877-696-6775
    • Visiting the Privacy Complaints page.
  • We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information, tell us, and we’ll follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • Include your information in a hospital directory

If you are unable to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest or to prevent a serious threat to health or safety.

In these cases, we never share your information unless you give us written permission:

  • Marketing purposes
  • Sale of your information
  • Most sharing of psychotherapy notes

In the case of fundraising:

  • We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures

We typically use or share your health information in the following ways:

Treat you

  • We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

  • We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it can pay for your services.

Bill for your services

  • We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services.

Other Uses and Disclosures

We may share your information for public health, research, and other lawful purposes. Learn more at HIPAA Guidance Materials.

Public health and safety

  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse or domestic violence
  • Preventing or reducing serious health threats

Research

We can use or share your information for health research.

Comply with the law

We share information if required by law, including with the Department of Health and Human Services for compliance checks.

Organ and tissue donation

We can share health information with organ procurement organizations.

Medical examiner or funeral director

We can share information to assist medical examiners or funeral directors.

Government and law enforcement

  • Workers’ compensation claims
  • Law enforcement requests
  • Health oversight agency requirements
  • Special government functions (e.g., military or national security)

Lawsuits and legal actions

We can share information in response to court or administrative orders or subpoenas.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will notify you promptly if a breach occurs that may have compromised your information.
  • We must follow the duties and practices described in this notice.
  • We will not use or share your information other than as described here unless you authorize us in writing.

Learn more at the HIPAA Privacy Practices page.

Changes to this notice

We may change the terms of this notice and will make the new version available in our office and on our website.

This Notice of Privacy Practices applies to all organizations on this site. See the appropriate page for contact information.

Site Privacy Policy

This website is provided for information and education purposes only. No doctor/patient relationship is established by your use of this site.

Collection of Information

We collect personally identifiable information (names, addresses, emails, etc.) when voluntarily submitted by visitors.

Cookie/Tracking Technology

The site may use cookies to understand usage and improve experience. Personal information is not collected through cookies.

Distribution of Information

We may share information with agencies for fraud prevention or legal compliance. We do not share consumer data for marketing.

Commitment to Data Security

Your personal information is kept secure. Only authorized personnel may access it. You may opt out of future emails.

Accessibility Statement

We are working to improve accessibility across our website. Here are some tips for improving your browsing experience:

  • Use accessibility features on your device
  • Enable text-to-speech or magnifier tools
  • Adjust text size, color contrast, and volume

Closed Captioning

Closed captioning provides a transcript of audio synchronized with video for those who are deaf or hard of hearing.

Volume Controls

Adjust both your device’s and media player’s volume for the best listening experience.

Assistance and Feedback

We welcome feedback on accessibility. Contact us via phone, email, or in person during business hours for assistance.

Office Policies

Insurance Policies

If we have received all of your insurance information on the day of the appointment, we will be happy to file your claim for you. You must be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. By law your insurance company is required to pay each claim within 30 days of receipt. We file all insurance electronically so your insurance company will receive each claim within days of the treatment. You are responsible for any balance on your account after 30 days, whether insurance has paid or not. We will be glad to send a refund to you once insurance has paid us.

PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. We do not have a contract with your insurance company — only you do. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment; we at no time guarantee what your insurance will or will not do with each claim. We also cannot be responsible for any errors in filing your insurance — once again, we file claims as a courtesy to you.

Office Policy Facts

Fact 1 – No Insurance Pays 100% of All Procedures

Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees. This is not true! Most plans only pay between 50%-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage, or the type of contract your employer has set up with the insurance company.

Fact 2 – Benefits Are Not Determined by Our Office

You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist’s actual fee. Frequently, insurance companies state that the reimbursement was reduced because your dentist’s fee has exceeded the usual, customary, or reasonable fee (“UCR”) used by the company.

A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable or above what most dentists in the area charge for a certain service. This can be misleading and is simply not accurate.

Insurance companies set their own schedules and each company uses a different set of fees they consider allowable. These allowable fees may vary widely because each company collects fee information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the “allowable” UCR fee. Frequently, this data can be three to five years old, and these “allowable” fees are set by the insurance company so they can make a net 20%-30% profit.

Unfortunately, insurance companies imply that your dentist is “overcharging” rather than stating that they are “underpaying” or that their benefits are low. In general, the less expensive the insurance policy, the lower the usual, customary, or reasonable (UCR) figure will be.

Fact 3 – Deductibles & Co-Payments Must Be Considered

When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for service is $150.00. Assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee, we can figure out what benefits will be paid. First, a deductible (paid by you), on average $50, is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00. Out of a $150.00 fee, they will pay an estimated $80.00, leaving a remaining portion of $70.00 (to be paid by the patient).

Of course, if the UCR is less than $150.00 or your plan pays only at 50%, then the insurance benefits will also be significantly less.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or change of employment.

Financial Policies

Payment for professional services is due at the time dental treatment is provided. Every effort will be made to provide a treatment plan which fits your timetable and budget and gives your child the best possible care. We accept cash, personal checks, debit cards, and most major credit cards.