Financial & Privacy Details
Insurance
Please note that we are an out-of-network provider. At Wellington Center for Laser Dentistry, we believe that healthcare decisions should be made by trained medical professionals, not insurance companies. We make every effort to provide you with the finest care and the most convenient financial options. We will gladly submit insurance claims to most insurance carriers; however, reimbursement will be based on your plan’s out-of-network benefits, and you will be responsible for the remaining balance.
We understand that dental care is an important investment in your health, and we offer flexible financing options to help make treatment more accessible and affordable. If you have any questions, please ask our staff. They are well-informed and up-to-date.
Please bring your insurance information with you to the consultation so that we can expedite reimbursement.
Financial Policy
Did you know that the money you put into a Flexible Spending Account or a Health Savings Account is pre-tax dollars? You can save money for health care using dollars earned, but that you haven’t paid taxes on!
Patient Billing
We accept the following payment methods:
Payment is due at the time of service, unless prior arrangements have been made. For your convenience, we can securely store your credit card on file for future visits, using enhanced encryption to keep your information safe.
Please be aware that you are responsible for all charges incurred at this office, regardless of insurance coverage or reimbursement.
Convenient Financing Options
- Citi Simplicity Card (Citibank) – 12 months no interest, subject to change
- Care Credit
HIPAA Privacy Policy
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.
Our Uses & Disclosure
We may use and share your information as we:
- Treat You (We can use your health information and share it with other professionals who are treating you)
- Run our organization
- Bill for your services
- Help with public health and safety issues (Preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, preventing or reducing a serious threat to anyone’s health or safety)
- Do research
- Comply with the Law
- Respond to organ and tissue donation requests
- Work with the medical examiner or funeral director
- Address workers’ compensation, law enforcement, and other government requests
- Respond to lawsuits and legal actions
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities.
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. We will provide a copy or a 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 with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
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 the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
If you have given someone medical power of attorney, agency pursuant to a Designation of Health Care Surrogacy, or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take 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. You can 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, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. 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 in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have the right to tell us to:
Share information with your family, close friends, or others involved in your care;
Share information in a disaster relief situation.
If you are not able to tell us your preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
We never share your information for marketing purposes unless you give us written permission
WE DO NOT SELL YOUR INFORMATION.
Our Responsibilities
We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and provide you with a copy of it.
We will not use or share your information other than as described here unless you give us written permission. Let us know in writing if you change your mind. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.
Notice Effective Date of this Notice: May 6, 2020. Privacy Contact Person: Liarra Thompson. [email protected] Wellington Center for Laser Dentistry Phone Number 561-791-8184
