Notices of Privacy Practices - 2013.pdf
We wish to take this opportunity to welcome you to Black Hills Modern Endodontics. Your safety and care is the top priority in this office. Our goal is to provide you with the best possible treatment for your endodontic diagnosis.
This office has been designed with equipment that reflects the latest in developments in design and function. The requirements of the Center for Disease Control (CDC) have been met or exceeded in our equipment and in our treatment delivery system, thus ensuring your safety. HIPAA and HITECK protocols are in place protecting your privacy.
Prior to beginning your treatment we will discuss and explain the procedure. Questions you may have regarding your endodontic problem will be answered.
Our treatment is limited to your endodontic diagnosis only. The final restoration or filling, if needed, will be placed by your dentist. Most endodontic treatment will be completed in either one or two appointments.
Prior to your appointment, it is important to explain our office financial policy. Financial arrangements for professional services will be discussed.
Payment for treatment received is due at time of service. Cash, check, Master Card, Visa, and Discover cards, as well as CareCredit are accepted for payment.
As a courtesy, we will file for payment of services with your insurance carrier. The co-pay your insurance carrier requires is due at time of service. Depending on your policy, that amount may be somewhere between 20% and 80% of the fee. If you have not met your deductible for your current policy year, we are required to collect that amount also. These fees will be payable at the completion of your first appointment.
We are unable to offer charge accounts where you make monthly payments. CareCredit is available to patients who would want a payment schedule.
MEDICAID AND MEDICARE
This office does not participate in the Medicaid program. Medicare will not pay for endodontic services.
Fees for services that will be rendered to you are available upon request and we encourage you to ask the business office what your approximate fee might be.
The final fee will be determined once your endodontic concern has been diagnosed.
For information on HIPAA, click on this link.
Black Hills Modern Endodontics | 306 7th St. Ste 200 Rapid City, SD 57701 | P: (605)791-5900 | Monday - Friday 8am - 4:30pm