 Financial Arrangements
We participate with many insurance plans: please feel free to discuss your plan with our staff. However, realize this is your insurance, and you should understand the benefits of your particular plan. We will be happy to complete insurance forms we do not participate with, so that you may be reimbursed.
We accept many credit cards and also offer various payment plan options. Please feel free to ask about these services. Agreed upon payments including co-payments will be due on the day of your appointment. We try to accommodate all of the patient's special needs. Please feel free to discuss any of these with our staff.
Payment is due at the time services are performed.
We participate in various insurance plans and accept Visa, MasterCard, Discover, and Care Credit.
Patient Privacy Notice
The following Notice describes Capital District Oral & Maxillofacial Surgeons privacy practices concerning medical information. This Notice is effective April 14, 2003.
Capital District Oral & Maxillofacial Surgeons 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.
Purpose of this Notice
In this notice, we describe how we may use and disclose your Protected Health Information to carry out treatment, payment, and health care operations and for other purposes permitted or required by law. This notice also describes your right to have access to your protected health information and to control that information. Protected Health Information is information about you that may identify you individually and that relates to your physical or mental health or condition and related health care services. As a health care provider, Capital District Oral & Maxillofacial Surgeons is required by law to maintain the privacy of your Protected Health Information and to provide you with this notice. Capital District Oral & Maxillofacial Surgeons is required to comply with the terms of this notice until and unless Capital District Oral & Maxillofacial Surgeons modifies this Notice.
Our Right to Change this Notice
Capital District Oral & Maxillofacial Surgeons may change the terms of this notice from time to time. When Capital District Oral & Maxillofacial Surgeons does, it will post a revised notice at its facilities and on its web site at "www.cdomsllc.com." You also may request that Capital District Oral & Maxillofacial Surgeons send you a copy of the revised notice by calling one of our offices and requesting a printed copy of the notice.
Capital District Oral & Maxillofacial Surgeons treats all your Protected Health Information as confidential. Capital District Oral & Maxillofacial Surgeons uses and discloses this information to provide treatment to you, to obtain payment for the services that Capital District Oral & Maxillofacial Surgeons provides to you, and for Capital District Oral & Maxillofacial Surgeons health care operations. Such uses and disclosures may be made by/to Capital District Oral & Maxillofacial Surgeons staff, contracted staff, volunteers, and business associates. Your approval is not required for these uses and disclosures.
Payment
Examples of payment activities include, but are not limited to the following: billing activities and collecting payment for the services that Capital District Oral & Maxillofacial Surgeons, LLC provides to you.
Public Health Activities
Capital District Oral & Maxillofacial Surgeons, LLC may disclose Protected Health Information to public health authorities that are authorized by law to collect health information for the purposes of preventing or controlling disease, injury, or disability, such as TB or sexually transmitted diseases. Capital District Oral & Maxillofacial Surgeons, LLC may in some cases use Protected Health Information to notify persons who may have been exposed to a disease or who may be at risk of spreading a disease. Capital District Oral & Maxillofacial Surgeons, LLC may use Protected Health Information to report to public health authorities adverse reactions to prescription medications or medical products or devices. Capital District Oral & Maxillofacial Surgeons may use Protected Health Information to report births, deaths, and other vital statistics. Reports of abuse or neglect. Capital District Oral & Maxillofacial Surgeons, LLC may disclose Protected Health Information to report suspected child abuse or neglect to Child Protective Services, the Police Department, or other government agency authorized by law to receive such reports. Capital District Oral & Maxillofacial Surgeons,LLC may also disclose Protected Health Information to report suspected abuse or neglect of an adult or suspected domestic violence to Adult Protective Services, the Police Department, or other government agency authorized by law to receive such reports.
Health Oversight Activities
Capital District Oral & Maxillofacial Surgeons, LLC may share Protected Health Information with an agency that is authorized to conduct health oversight activities. Health oversight activities include audits, investigations, inspections, or licensure and certification surveys. These activities are necessary to monitor organizations that provide health care and to ensure compliance with applicable state and federal laws and regulations.
Government Monitoring Activities
Capital District Oral & Maxillofacial Surgeons, LLC may share Protected Health Information with government agencies that provide funding for and that audit, oversee, and monitor our programs. United States Department of Health and Human Services. Capital District Oral & Maxillofacial Surgeons, LLC may share Protected Health Information with the Secretary of the United States Department of Health and Human Services as needed to monitor our compliance with your privacy rights.
Lawsuits and Disputes
Capital District Oral & Maxillofacial Surgeons may share Protected Health Information with courts or administrative agencies that are authorized to resolve lawsuits or disputes. Capital District Oral & Maxillofacial Surgeons may share Protected Health Information as required by court order, subpoena, a discovery request, or other lawful process issued by a judge.
Law Enforcement
Capital District Oral & Maxillofacial Surgeons may share Protected Health Information in response to a request received from a law enforcement official in response to a court order, subpoena, warrant, summons, or similar lawful process. As required by state or federal law, Capital District Oral & Maxillofacial Surgeons will use Protected Health Information to notify law enforcement personnel or other authorized government authorities about risks and threats of harm to you or others. As required by state or federal law, Capital District Oral & Maxillofacial Surgeons will use Protected Health Information to notify an individual at risk of threat or harm.
Coroners, Medical Examiners, or Funeral Directors
Capital District Oral & Maxillofacial Surgeons may share Protected Health Information with a coroner, medical examiner, or funeral director, for example, to identify a deceased person or determine the cause of death.
Disclosures to Parents and Legal Guardians
If you are a minor or have a legal guardian, Capital District Oral & Maxillofacial Surgeons shares your Protected Health Information with your parents (with limited exceptions mandated by state law), guardian, or the persons responsible for your care. Capital District Oral & Maxillofacial Surgeons may also disclose Protected Health Information to other family members involved in your care.
Reminders
Capital District Oral & Maxillofacial Surgeons may use and disclose Protected Health Information to contact you as a reminder about an appointment for treatment.
Treatment Alternatives
Capital District Oral & Maxillofacial Surgeons may use and disclose your Protected Health Information to tell you about alternative treatment options that may be of interest to you. Health-related Services. Capital District Oral & Maxillofacial Surgeons may use and disclose your Protected Health Information to tell you about health-related services or benefits that may be of interest to you.
No Use or Disclosure for Marketing Purposes
Capital District Oral & Maxillofacial Surgeons does not use your protected health information or other private information about you for marketing purposes.
All other uses and disclosures
For all uses and disclosures other than those listed above, your or your legal guardian’s written authorization is required. Capital District Oral & Maxillofacial Surgeons will not otherwise disclose your Protected Health Information without your or your legal guardian’s written authorization. You or your legal guardian may withdraw such authorization at any time.
Your Right to Request Restrictions
You have the right to request restrictions on how Capital District Oral & Maxillofacial Surgeons uses and discloses your Protected Health Information. If you wish to make such a request, direct that request to one of our offices. Capital District Oral & Maxillofacial Surgeons is not required to comply with your request, but Capital District Oral & Maxillofacial Surgeons must consider it and respond to you.
Your Right to Inspect Your Protected Health Information, to Make Corrections, to Request Confidential Communications, and to an Accounting of Disclosures Right to inspect and copy. You have the right to inspect and copy the Protected Health Information that Capital District Oral & Maxillofacial Surgeons has about you in our records and in the records of business associates to whom Capital District Oral & Maxillofacial Surgeons discloses that information.
Right to request an amendment or correction
You have the right to request that information about you in our records or that of our business associates be amended or corrected. Capital District Oral & Maxillofacial Surgeons does not have to agree to the amendment or correction, but Capital District Oral & Maxillofacial Surgeons must respond to and keep a record of your request and its response in your file.
Right to request confidential communications
You have the right to request that Capital District Oral & Maxillofacial Surgeons communicate with you about health matters in a particular way or at a certain location. For example, you can request that Capital District Oral & Maxillofacial Surgeons only contact you by mail or at an address other than your residence. Capital District Oral & Maxillofacial Surgeons will attempt to accommodate all reasonable requests.
Right to an accounting of disclosures
Capital District Oral & Maxillofacial Surgeons is not required to keep a record of disclosures of your Protected Health Information for treatment, payment, and health care operations; for disclosures made pursuant to any written authorization by you, your guardian, or parents; or for disclosures made to your legal guardian or (in most cases) parents and other family members involved in your care. Capital District Oral & Maxillofacial Surgeons is required, and Capital District Oral & Maxillofacial Surgeons business associates are required, to keep a record of all other disclosures. You have the right to receive an "accounting" (a record) of these disclosures.
How to exercise these rights Requests for access or to make corrections
Direct all requests for access to your Protected Health Information and to make corrections to your Protected Health Information to our office in which the services were performed.
Your Right to Make Complaints About Violations of Your Privacy Rights and Where to Make Such Complaints
If you believe that your privacy rights have been violated, you have the right to file a complaint. You may file a complaint with Capital District Oral & Maxillofacial Surgeons. All complaints must be made in writing
You also may file a complaint with the Secretary of the United States Department of Health and Human Services.
No Retaliation
Capital District Oral & Maxillofacial Surgeons assures you that it will not retaliate against you for filing a complaint or for otherwise exercising your rights under this notice. Effective Date of this Notice: April 14, 2003.
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