SKY Pediatric Dentistry Office Policies
Thank you for choosing SKY Pediatric Dentistry for your child’s dental treatment! Please read SKY Pediatric Dentistry’s Office Policies. Feel free to contact us at 270-715-5437 in Bowling Green or 270-874-4971 in Hopkinsville. You can also email email@example.com if you have any questions or comments.
2017 SKY OFFICE POLICY “HIGHLIGHTS”
- Please do not take VIDEO. We allow pictures, just ask first please. Thank you!
- We have a $25 no show/late fee and we donate 100% of this to the Commonwealth Health Free Clinic. You are late if you are not here within 15 minutes of your child’s appointment. We encourage you to please call before 9am if you must cancel or reschedule your child’s appointment to avoid being a “no-show” to your appointment.
- Effective August 1st 2017, patients with Medicaid insurance need a REFERRAL to be seen at SKY Pediatric Dentistry. We are granting exceptions for Foster Children and Refugees.
- If you no-show for a Sedation or Hospital Appointment, you will not be rescheduled and may be dismissed from the practice. These appointments are very limited and it is very important to show up on time.
- We want to provide the best environment for kids and a great work environment for SKY Staff. Foul language will result in a dismissal from the practice.
2017 SKY OFFICE POLICY “IN DEPTH COVERAGE”
In an Emergency... SKY Staff are available to assist your call at 270-715-5437 from 7:00am-6pm Monday through Thursday and until 5pm on Fridays. After-Hours and on Holidays, you can call or text message Dr. Mandy Ashley at 270-792-0703 for emergencies only please. The Doctor will not be able to assist with scheduling, insurance and other non-emergency questions. For non-emergency questions, please call the office at 270-715-5437 and leave a message or send us an email at firstname.lastname@example.org and we will respond on the next Business Day.
How Are Appointments Scheduled?
We recommend dental treatment visits in the morning when your child is less tired and likely to be more cooperative. We provide school excuses for dental visits to our office.
Since appointment times are reserved exclusively for each patient, we ask that you please notify our office by 9am if you are unable to keep your child’s appointment to avoid the $25 no-show fee. This will ensure that another patient who needs our care can be scheduled because there is sufficient time to notify them. We realize that unexpected things can happen, but we ask for your assistance in this regard.
Text Reminders: We use a system called Dentrix that will send out text or email reminders prior to your child’s visit to help you remember the date and time of the dental appointment. We also send out a reminder postcard 1 month before your “6-month Recall” cleaning visit.
First Visit Information
As a Board-Certified Pediatric Dentist, Dr. Mandy Ashley caters to the unique needs of all children and also people with special needs. If your child has developmental or behavioral issues that may affect his or her ability to accept dental treatment, please inform us when making the appointment. Understanding your child’s unique needs allows us to better serve them. We offer “Roll Up, Call Up” for parents who feel that their child may be disruptive or unable to cope with a busy lobby waiting room. Call us at 270-715-5437 in BG and 270-874-4971 in Hopkinsville when you park your car and we will prepare your child’s room and escort you directly into the room, bypassing the lobby.
“Come On Back” Policy: SKY Pediatric Dentistry is purposefully designed to welcome parents into the treatment areas for all treatment with the exception of oral-sedation appointments.
In order to create the best experience for your child, we have a few rules…
- Parents are asked to refrain from using scary words like “needle/shot, drill, pull/yank a tooth.” Instead, the SKY Staff will use funny, non-threatening words to describe the treatment like “Scooby-nose, sleepy juice, monkey wiggles, brush-car, teeth trampoline, cookie picture, sugar bugs” and more.
- Parents will act as “silent observers” during initial treatment.
- We want to increase your understanding of what a Pediatric Dentist does and how our office differs from your previous dental experiences. Please ask questions, we are happy to help you learn more.
- Please refrain from eating or drinking in the treatment area.
- We have space in the treatment rooms for up to two parents. If there are more adults present, we will try to accommodate your family, but may kindly ask that additional family members wait in the lobby.
Cellular Phones in the Treatment Areas
Please refrain from talking on your cell phone when you are in the treatment areas. If you need to make or take a call, please step out into the waiting area or the covered area outside. You may ask for permission to take photos of your child’s dental visit, but VIDEO is NOT ALLOWED AT ALL.
Insurance and Financial Information
Outstanding patient service is the goal of SKY Pediatric Dentistry. We want to make certain that our financial policies are clear and understood by you. Please understand that payment of your bill is considered a part of your child’s treatment.
Every effort will be made to provide a treatment plan that fits your timetable and budget, and gives your child the best possible care. Please keep in mind, that the parent bringing the child to the dental appointment is responsible for payment of the child’s dental treatment. If another parent or guardian is responsible for the costs of dental care, we will need that person to call us and make arrangements for payment prior to the appointment.
You will be provided with an estimate of your out-of-pocket expenses BEFORE dental treatment (sealants, Nitrous Oxide, fillings, etc.) is performed. Your out-of-pocket estimate is due at the time of checkout on the day the treatment is completed. You will be given the opportunity to let us know if you would like to proceed with treatment or if you would like to reschedule treatment.
Which payment options do you accept?
We accept cash, money order, personal check, debit cards and most major credit cards, including Care Credit. Care Credit is a revolving line of credit that can be used for current balances as well as future treatment and carries no interest if paid in full in 6 months. If extensive dental treatment is needed, special financial arrangements may be made. Our treatment coordinators can help you understand your payment options.
If paying by check, there will be a charge of $25 for any check that is returned due to insufficient funds. A check returned due to insufficient funds may require a credit card number to be placed on file for future payments.
SKY Pediatric Dentistry sends monthly statements for outstanding patient balances. We expect timely payment for our services. If we have not heard from you by your third statement, your account will be sent to Hillcrest, a collections agency. To re-join the practice, the balance must be paid in full.
Our Office Policy Regarding Dental Insurance
If you have insurance, we will make a good faith estimate of your benefits and defer billing you that amount for 30 days. We will take care of completing and filing the appropriate claims forms with your insurance company. We file nearly all insurance electronically so your insurance company will receive each claim within days of the dental treatment. We will also track your claim and make sure that it is paid in a timely manner. We will follow-up with your insurer when claims are not processed efficiently and attempt to expedite payment. We are also happy to provide your insurance company dental X-rays or any other information they may require. If your insurer denies coverage, or if we otherwise do not receive payment within 60 days from filing your claim, the amount will then become due and payable by you. You are responsible for any balance on your account after 60 days, whether insurance has paid or not.
PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment. At no time do we guarantee what your insurance will or will not do with each claim. Please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment status.
Very few Dental Insurances Pay 100% of All Procedures. Your insurance may have co-pays for treatment and may also have a maximum family dental benefit or a high dental deductible before the plan “kicks in”. It is your responsibility to carefully consider your child’s dental insurance plan and understand what your plan offers.
What if we do not have dental insurance?
For our patients without dental insurance, we accept cash, money order, check, debit card, most major credit cards and CareCredit. Care Credit is a revolving line of credit that can be used for current balances as well as future treatment and carries 0% interest if paid in full in 6 month. If lengthy treatment is needed, special financial arrangements may be made.
Broken or Missed Appointment Policy
The time for your child’s dental appointment has been exclusively reserved for you and your child. Without proper notification of your absence for an appointment, another child who has been waiting for dental care will not receive the dental care they need because we did not have adequate time to notify them. Therefore, we require that you call prior to 9am on the day of your child’s appointment to cancel without being listed as a “no-show”.
$25 No Show Fee: If you do not call before 9am to cancel, or you show up more than 15 minutes late, you will need to pay the $25 no-show fee to schedule another appointment. 100% of this fee is donated to the Commonwealth Health Free Dental Clinic.
Medicaid: If you have Medicaid insurance, we cannot charge you a No-Show fee as per our contract with your insurance. Instead, if you miss an appointment without calling prior to 9am or are more than 15 minutes late to an appointment, you will only have access to our Monday “Clinic-Block Scheduling” and our “Same-Day Scheduling”. “Clinic-Block” is 11am-1pm on Mondays. “Same-Day” means you call us prior to 9am on the day you want to come in. If we have a cancellation, we will work you in. After you have showed up ON TIME for a “Clinic-Block” or “Same-Day” appointment, you will go back to having access to our regular appointments, with the exception of our 3:30pm appointments.
If for any reason you decide to leave our practice, you have the right to request copies of your child’s dental records and dental X-rays. You will need to sign a release form and indicate whether you would like to pick up copies of the dental record and prints of the digital X-rays or if you would like us to mail them to you or to another dental provider. We can also provide you with a list of Board Certified Pediatric Dentists in your new town. SKY Pediatric Dentistry provides this service free of charge because we want to ensure continuity of excellent dental care for your child.
School Closings and Bad Weather
In the event of inclement weather or facility issues, SKY Pediatric Dentistry will do our best to contact you via phone, text or email to alert you to the situation and to make arrangements for another appointment time. We post weather-related closings on the WBKO Polar Report. We will also issue an alert on our Facebook Page (SKYPediatricDentistry) and on our website (www.skypediatricdentistry.com) and post a notice on our office front door.
***Please consider liking SKYPediatricDentistry on Facebook for all of the most UP-TO-DATE information on our practice including weather closings and special events, contests and PRIZES!!!
Thank you for taking the time to read through these policies ☺
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.
The Health Insurance Portability & Accountability Act of 1996 ("HIPAA") is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you, the patient, significant rights to control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information.
As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.
We may use and disclose your medical records only for each of the following purposes:
- Treatment, payment and health care operations.
- Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. An example of this would include treatment for pain or injury to your child’s teeth.
- Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review. An example of this would be sending a bill for your child’s visit to your insurance company for payment.
- Health care operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service. An example would be an internal quality assessment review.
We may also create and distribute de-identifiable health information by removing all references to individually identifiable information.
We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
We may also use or disclose your personally-identifiable health information
- To your family and friends: We must disclose your information to you. We may also disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment of your healthcare, but only if you agree that we may do so, or if we are presented a valid legal document showing authority of another person to act on your behalf, as, for example, a medical power of attorney or declaration of guardianship.
- To persons involved in your care: We may use or disclose health information to notify, assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care of your general condition. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to use uses or disclosure.
- As required by law: we may use or disclose your health information when we are required to do so by law.
- In case of suspected abuse or neglect: we may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.
- For other governmental purposes: we may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to correctional institution or law enforcement official having custody of protected health information of inmate or patient under certain circumstances.
Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Privacy Officer:
- The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are, however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
- The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.
- The right to inspect and copy your protected health information.
- The right to amend your protected health information.
- The right to receive an account of disclosures of protected health information.
- The right to obtain and we have the obligation to provide to you a paper copy of this notice from us at your first service delivery date.
- The right to request a written acknowledgment that you have received a copy of our Notice of Privacy Practices, and an obligation to document our good faith efforts why an acknowledgment was not obtained.
We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.
This notice is effective as of April 14, 2003 OR the date office opened if later than April 14, 2003, and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may request a written copy of a revised Notice of Privacy Practices from this office.
You have recourse if you feel that your privacy protections have been violated. You have the right to file a formal, written complaint with us at the address below, or with the Department of Health & Human Services, Office of Civil rights, about violation of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint.
For more information about HIPAA or to file a complaint:
The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Ave. S.W.
Washington, D.C. 20201