Our only concern is your welfare. Here is the information you need before your appointment. If you can't find an answer, you may always reach us using the "Contact Us" tab above.
Preferred Provider - in addition to being contracted with most major insurance providers for Utah, we also accept and work with all insurance companies. Please contact your insurance company for details.
Claims - as a courtesy for our patients, we can submit claims to your insurance. Since we aren't parties to your contract, we can't guarantee payment.
Overdue Claims - we will process claims for up to 90 days. After that time, we will send you the claim forms for direct patient submission.
Changes - please keep us apprised of any changes to your insurance policy. We keep some information on file, but benefits can change often.
Pre-Treatment Authorizations - all fees we quote in office are just estimations. If you would like an exact insurance benefit, we would be happy submit a "pre-treatment authorization" form. This does take time and may delay treatment.
Dual Coverage - we will work with both insurances for those patients who are covered by more than one dental insurance. This takes additional processing time and will not cover 100% of treatment fees.
Updates - HIPAA and other healthcare information requirements are constantly changing, therefore our paperwork periodically may change as well. We truly appreciate the time you take to fill out your information completely and honestly as we work with federal and state protocol to keep your information accurate and protected.
Be Prepared - if you're an overachiever, please fill the secure Google form at the bottom of this page. If you would prefer to print and bring your paperwork, please contact our office and we will email a copy of our paperwork to you that you may complete.
Policy Changes - we reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and make the new notice available upon request. You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us according to the means outlined in this notice.
Usage in Treatment - we may use or disclose your health information to a physician/dentist, dental auxiliaries, students and other healthcare providers providing treatment to you.
Healthcare Operations - we may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performances, conducting training programs, accreditation, certification, licensing or credentialing activities.
Third Party Usage - we may utilize one or more third-party service providers to send email or other communications to you on our behalf, including Patient satisfaction surveys. These service providers are prohibited from using your email address or other contact information for any purpose other than to send communications on our behalf.
Electronic Communications - text or email messages may include protected health information about you. Once information is disclosed, it is possible that it will no longer be protected by the federal medical privacy law and could be disclosed by the person or agency that receives it. Our will not use or disclose your health information, except as provided for in the law, without your authorization. You have the right to revoke any Authorization at any time in writing. If you revoke this authorization, it will not apply to any information already released as a result of prior authorization. You will not be denied or refused treatment were you to opt out of electronic communications from our office.
Access - you have the right to look at or get copies of your health information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. We may charge a fee for producing dental records and X-rays as allowed by law.
Disclosure Accounting - you have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes other than treatment, payment, healthcare operations and certain other activities for the last 6 years, but not before April 14, 2003. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.
Restriction - you have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency). When you pay in full outside of your insurance plan for services you may request that we restrict this information and not disclose it to your healthcare plan or insurer.
Amendment - you have the right to request that we amend your health information. This request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances.
Electronic Notice - If you received this notice on our web site or by electronic mail (e-mail), you are also entitled to receive this notice in written form.
Required by Law - we may use or disclose your health information when we are required to do so by law.
Collections - for the collection of monies owed by you in the case of legal action, information concerning your account may be sent to a collections agency or attorney.
Family - we must disclose your health information to you, as described in the Patient Rights section of this notice. We may disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may do so.
Payment - in addition to accepting cash and check payments,we process all major credit cards, including MasterCard, Visa, American Express, and Discover.
CareCredit - we do accept CareCredit payments in our office. This is a great option for patient without insurance benefits as other healthcare providers may accept this payment and has flexible payment schedules with the possibility of waived interest. Please visit their website for more information and application: carecredit.com
Overdue Accounts - accounts over 60 days will be charged interest at 1.5% per month (18% annually).
Non-Insured Patients - we have an excellent in-house discount program for our patients without dental insurance. Please contact our office for details.
Other Options - in order to be able to make the best dentistry available, we have various in-office payment options. These depend on the treatment required and quotes are available after a consultation and exam by Dr. Porter.
Collections - if legal action is necessary, a fee of 40% of the principal balance owing will be added to your account. By receiving treatment, you agree to pay all costs and reasonable attorney's fees if a suit is stated to collect monies owed by you.
Feel free to contact us at any time if you have questions about the information above. We appreciate your feed-back and will respond as soon as we can.