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Cancellation Policy for Restorative
and Hygiene Appointments:
We ask for at least 48 hours advance notice for
canceling or rescheduling an appointment; otherwise, a $50 fee may
be assessed to your account
The treatment that is planned for you is specific to
you. It is important for you to keep the scheduled dates and times
to properly complete
your treatment. A broken appointment is a loss to
three people --- the patient who missed the valuable time, the
patient who could have taken
the valuable time; and the doctor who was fully
staffed and prepared for the appointment.
Insurance
We provide services for our patients with the
understanding that they are responsible for payment in accordance
with our financial policy. We will prepare and submit forms and
reports to assist you in obtaining maximum benefits available,
however the dentist’s treatment recommendations
or fees are not affected by the presence or absence
of insurance benefits. Treatment recommendations are based on your
dental needs and desires
and are not a reflection of your dental benefits.
Your dental benefits are a contract between you, your employer and
the insurance company,
therefore we do not confirm insurance eligibility or
predetermine recommended treatment.
Collections
In the event the balance becomes more than 60 days
overdue, billing may be turned over to an outside collection
agency. The responsible party
listed above agrees to pay interest, collection
and other legal expenses related to collection of fees owed. Waiver
of any breach of any time or condition shall not constitute a waiver
of any further term or condition.
Privacy Policy:
This summary
discloses how Healthcare information about you may be used by Bel
Red Dentists. A full notice of your privacy rights has been provided
to you.
Treatment,
Payment, Operations. We may use health information
about you for treatment, to obtain payment for treatment, for
administrative purposes, and to evaluate the quality of care that
you receive.
Uses and
Disclosures for Appointment Reminders.
We may use and
disclose your Healthcare information to contact you as a reminder
that you have an appointment at the office. If you request that
such communications be made confidentially, please contact our
office in writing. We will accommodate all reasonable requests.
Authorization
for Use and Disclosure.
We will not
disclose your information to others unless you tell us to do so, or
unless the law authorizes or requires us to do so.
Public
health, research, health and safety, government, works compensation.
We may
disclose your information for public health activities, research,
health and safety, governmental function, and in order to comply
with workers compensation laws and regulations.
Rights.
You
have a right to inspect and copy information used to make decisions
about your care, to request an amendment of the information, to an
accounting of disclosures, to request communication with you by
alternate means, to request restrictions on the information we use,
and to revoke your authorization for release of information.
Complaints.
You may complain to the Privacy Information Director at
206.223.0033 or to the Department of Health and Human resources if
you believe your privacy rights have been violated. You will not be
retaliated against for filing a complaint.
Organization
duties. We
must maintain the privacy of protected health information, provide
you with notice of our legal duties and privacy practice with
respect to your health information, abide by the terms of the
notice, notify you if we are unable to agree to the requested
restriction on how your information is used or disclosed,
accommodate reasonable requests you may make to communicate with
health information by alternative means or by alternative locations,
and obtain your written authorization to use or disclose your health
information for reasons other than those listed above and permitted
under law.
Questions.
If you have any questions, please
contact the Privacy Officer at 206.223.0033. |
