Healey Dental Care                                  905-857-1818 
             Family and Cosmetic Dentistry      12788 HWY 50, Unit A5, BOLTON, ON L7E 4G1          Bring Home A Smile!

Family and Cosmetic Dentistry

CLINIC POLICIES

PAYMENT POLICY


We accept payment for services by any of the following methods: VISA, MASTERCARD, DEBIT CARD, CASH, and ASSIGNMENT OF BENEFITS of insurance plans (payment directly from insurance company). Payment is due on the date service is rendered, or financial arrangements made prior to treatment. As a courtesy to our patients we do accept assignment of benefits as long as it is permitted by the insurance carrier. Patients with assignment of benefits must understand that any outstanding balances are their responsibility and payable at the time services are rendered. Please note that assignment of benefits is not permitted by all insurance plans. You are requested to check with your insurance carrier if your plan allows assignment. If your plan is non-assignment, you will have to pay for services in full on the day of services and we will submit your claim electronically or by mail and you would receive reimbursement from your insurance carrier directly.
For any major treatment (crowns, bridges, veneers, implants or invisalign braces), payment plans can be set up, please ask us for details.

Please make sure we have your up to date personal information such as address and phone numbers as well as insurance plans information.

OFFICE PRIVACY POLICY


NOTICE OF PRIVACY PRACTICES

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.
If you have any questions about this Notice, please contact our Privacy Contact, who is the
PRIVACY OFFICER, Dr. Laila Roshan. We are required by law to maintain the privacy of protected health information and to provide you with this Notice of our legal duties and privacy practices with respect to protected health information. Protected health information is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. We are required to abide by the terms of this Notice currently in effect. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice by, calling our Privacy Contact and requesting that a revised copy be sent to you in the mail.

1. Retention & Safeguards

Personal Information will be kept only as long as needed for the intended purposes or as required by law. Safeguards have been established by Healey Dental Care that is intended to protect Personal Information against loss, theft, copying, and unauthorized disclosure, use or modification. Access to Personal Information is restricted to authorized employees and authorized service providers who need it to perform their work. Personal Information is stored in secure databases on this website and in locked offices on our premises during non-operating hours.

2. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

Uses and Disclosures of Protected Health Information for Treatment, Payment, or Operations
 
Your protected health information may be used by your dentist for treatment, payment and health care operations as described in this Section 1 without authorization from you. Your protected health information may be used and disclosed by your dentist, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of the dentist's practice. Following are examples of the types of uses and disclosures of your protected health care information that the dentist's office is permitted to make without your specific authorization. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.

Treatment:
We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party, consultations with another dentist, or your referral to another dentist for your diagnosis and treatment.

Payment:
Your protected health information will be used, as needed, to obtain or provide payment for your dental services, including disclosures to other entities. This may include certain activities that your health insurance plan may undertake before it approves or pays for the services we recommend for you such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you, and undertaking utilization review activities.

Operations:
We may use or disclose, as needed, your protected health information in order to support the business activities of your dentist's practice. These activities include, but are not limited to: quality assessment and improvement activities; reviewing the competence or qualifications of professionals; securing stop-loss or excess of loss insurance; obtaining legal services or conducting compliance programs or auditing functions; business planning and development; business management and general administrative activities, such as compliance with the Health Insurance Portability and Accountability Act; resolution of internal grievances; due diligence in connection with the sale or transfer of assets of your dentist's practice; creating de-identified health information; and conducting or arranging for other business activities.
We may also call you by name in the waiting room when your treating provider is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
We will share your protected health information with third party business associates that perform various activities (e.g., billing, transcription services, accounting services, legal services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.
We may use or disclose your protected health information, as necessary, to provide you with information about a product or service to encourage you to purchase or use the product or services for the following limited purposes: (1) for your treatment; or (2) for your case management or care coordination, or to direct or recommend alternative treatments, therapies, dentists, or settings of care.

Uses and Disclosures of Protected Health Information Based upon Your Written Authorization

Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke this authorization, at any time, in writing, except to the extent that your dentist or the provider's practice has taken an action in reliance on the use or disclosure indicated in the authorization.

Emergencies: We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care about your medical condition or in the event of an emergency or of your death.

Public Health: As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications, and reporting disease or infection exposure.

Judicial and Administrative Proceedings:
We may disclose your health information in the course of any administrative or judicial proceeding.

Change of Ownership: In the event that Healey Dental Care is sold or merged with another organization, your health information/record will become the property of the new owner.


3. YOUR RIGHTS

Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights. You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in your chart, including medical and billing records and any other records that your dentist and the practice uses for making decisions about you. Under federal law, however, you may not inspect or copy the following records: information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Contact if you have questions about access to your medical record.

You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice. Your request must state the specific restriction requested and to whom you want the restriction to apply. Your dentist is not required to agree to a restriction that you may request. If your dentist believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If your dentist does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with the office Privacy Contact. You may request a restriction by speaking with Dr. Laila Roshan who is the Privacy Contact.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Contact.

You may have the right to have your provider amend your protected health information. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Contact to determine if you have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes, or disclosures for which you have signed an authorization. You have the right to receive specific information regarding these disclosures and the right to receive this information is subject to certain exceptions, restrictions and limitations.

You have the right to obtain a paper copy of this Notice from us, upon request, even if you have agreed to accept this Notice electronically.

4. Disclaimer

No one should act upon the information on this site without a thorough examination and appropriate consideration of the facts of their particular situation. You assume total responsibility and risk for your use of this and all other Internet sites. Healey Dental Care and anyone associated or affiliated with Healey Dental Care, or this site, makes no express or implied warranties, representations or endorsements whatsoever with regard to any information, service or product provided through this site or on the Internet generally, and they shall not be liable for any cost or damage arising either directly or indirectly. It is solely your responsibility to evaluate the completeness and usefulness of all information, services, and products provided through this site or the Internet generally. Under no circumstances will Healey Dental Care and anyone associated or affiliated with Healey Dental Care, or this site, be liable for any direct, indirect, incidental, special, punitive or consequential damages that result in any way from your use of or inability to use this site or to access the Internet generally or any part thereof, or your reliance on or use of information, services or products provided on or through this site or that result from mistakes, omissions, interruptions, deletion of files, errors, defects, delays in operation or transmission, or any failure of performance. Data or mail transmitted on the Internet is not always secure. Healey Dental Care will not be responsible for any damages you may suffer by the transmission by you of confidential or sensitive information. The Internet contains viruses and other hacking devices that can damage your property and you are exposed at your own risk. The Internet contains unedited materials some of which may be offensive to you and your access to such materials is at your own risk. 

5. COMPLAINTS

You may complain to us or to the Privacy Contact if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Contact of your complaint. We will not retaliate against you for filing a complaint. You may contact Dr. Laila Roshan, for further information about the complaint process.  This Notice was published and became effective on April 2009, upon opening of Healey Dental Care. 


 
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