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Effective Date: January 2024
At Dental Faith, we understand the importance of protecting your personal and health information. All members of our practice team are required to follow our confidentiality safeguards as part of their employment or service agreement with the practice.
This notice explains how we may use and disclose your health information, the steps we take to protect it, and the rights you have regarding your information.
Our website address is https://dentalfaith.com.
This notice describes the privacy practices of Dental Faith Aesthetic & Family Dentistry.
“We,” “us,” and “our” refer to Dental Faith. “You” and “your” refer to our patients.
This notice applies to health information that we create or receive and that can be used to identify you. It explains the ways we may use or disclose your health information and describes your rights regarding that information.
We are required by law to:
We may use your health information to provide dental treatment and services, including dental cleanings, examinations, X-rays, and other procedures.
We may disclose information about you to dental specialists, physicians, laboratories, or other healthcare professionals involved in your care.
We may use or disclose your health information for activities needed to operate our dental practice. These activities may include:
We may use and disclose your health information to bill for services and obtain payment from health plans, insurance companies, or other responsible parties.
We may use your health information to contact you about an appointment. We may contact you by telephone, voicemail, text message, email, postcard, or letter.
We may use or disclose your health information to tell you about treatment options, alternatives, or health-related services that may be of interest to you.
We may disclose relevant health information to a family member, caregiver, or friend involved in your treatment or payment for your care when you have given permission or have not objected.
If you are unavailable or unable to communicate your wishes, we may make a disclosure when we believe it is in your best interest and permitted by law.
You have the right to request a copy or transfer of your dental X-rays. A completed authorization form is required before records can be released.
Records will generally be sent within two to three business days after we receive your written request. Dental Faith charges a $25 administrative fee for providing an electronic or paper copy of your X-rays, when permitted by law.
Dental Faith uses video surveillance in portions of the clinic for patient and team safety. Surveillance footage is not shared with outside parties except when required or permitted by law.
Surveillance cameras are not placed in areas where patients or team members have a reasonable expectation of privacy.
If you need to cancel or reschedule an appointment, please contact us at least 24 hours in advance. Appointments that cannot be confirmed may be offered to another patient.
A $50 fee may be charged for a canceled or missed appointment when the required notice is not provided. If an emergency prevents you from giving advance notice, please contact our office so we can discuss the circumstances with you.
Please do not cancel an appointment by voicemail or text message. Speak directly with a Dental Faith team member during office hours to confirm your cancellation.
Please arrive at least 10 minutes before your scheduled appointment. If you arrive 15 minutes late or more, you may be asked to reschedule unless we are still able to accommodate you.
Minors must be accompanied by an adult. The adult accompanying the minor is responsible for payment for services provided during the appointment.
If a parent or legal guardian authorizes another caregiver to bring the minor to the appointment, the required permission form must be completed before the visit.
Payment is due in full at the time treatment is provided unless other payment arrangements have been approved by Dental Faith.
If we file an insurance claim on your behalf, you are responsible for paying your estimated deductible, copayment, coinsurance, and any amount we expect your plan will not cover at the time of treatment.
We work to obtain accurate information about insurance benefits before treatment. However, insurance coverage and payment cannot be guaranteed until the claim has been processed.
You are responsible for all treatment charges, including amounts your insurance company does not pay.
A $30 fee will be charged for each returned check. If you have previously submitted a returned check, Dental Faith may no longer accept personal checks from you.
Balances not paid within 30 days may be charged interest at a rate of 1.5% per month, or 18% annually, subject to applicable law.
Patients are encouraged to understand their insurance benefits and monitor their plans for claim processing and payment.
If your account is referred to an outside collection agency or attorney, you may be responsible for collection costs, agency commissions, reasonable attorneys’ fees, court costs, and related expenses to the extent permitted by law.
For an account collected before a lawsuit is filed, Dental Faith may add 43% to the principal balance to account for the collection agency’s commission, where permitted by law.
Dental Faith reserves the right to change this notice and its privacy practices at any time. Changes may apply to information we already have and information we receive in the future.
When a material change is made, we will revise this notice and post the updated version on our website and in our office. A copy will also be available upon request.
If you believe your privacy rights have been violated or have concerns about how your health information was used or disclosed, you may file a complaint with Dental Faith by contacting our HIPAA Privacy Official.
Dental Faith will not retaliate against you for filing a complaint.
If you have questions about this notice, our privacy practices, or your health information, please contact:
Dental Faith Aesthetic & Family Dentistry
HIPAA Privacy Official: Dr. Paula M. Fedler
Address: 390 Harding Place, Suite 101
Nashville, TN 37211
Email: drfedler@dentalfaith.com
Phone: 615-285-3949
Fax: 615-285-3950
Website: dentalfaith.com
