Patient Authorizations
When completing our new patient registration forms, parents are asked to authorize the dentist to take x-rays, study models, photographs, or any aids deemed appropriate by the dentist in charge of your child’s care to make a thorough diagnosis of your child’s dental needs. You will also authorize the dentist to perform any and all forms of treatment, medication, and therapy that may be necessary for your child’s dental health. Treatment recommendations will be reviewed on an individual basis, and you will be asked to provide consent or non-consent, either in writing or verbally, separately when these recommendations are presented.
Appointment Policy
Craft Smiles Pediatric Dentistry REQUIRES parents to CONFIRM appointments PRIOR TO 2:00 PM on the day before your child's appointment OR the appointment will be CANCELED. Our office confirms all appointments by email, text, or phone call. If we do not receive a reply from you in any of these formats, it will be considered a missed appointment.
A $45 fee will be incurred for a missed appointment or if an appointment is canceled with less than 24 hours' notice.
Insurance & Payment Policy
- It is your responsibility as the parent to verify that Craft Smiles Pediatric Dentistry is a participating provider with your dental insurance company and to understand the benefits available to you. If insurance is not verified before the appointment, you will be held financially responsible for all services rendered.
- Parents are financially responsible for all charges for any and all services rendered. If Craft Smiles Pediatric Dentistry participates with your insurance plan, Craft Smiles Pediatric Dentistry will bill your insurance company, and you will be responsible for any charges remaining after the insurance reimbursement has been processed, including payment for any services that are considered non-covered by your insurer.
- All co-payments and/or deductibles are due at the time of your child's visit.
- If Craft Smiles Pediatric Dentistry does not participate with your insurance or you do not have insurance, your child will be seen as a private-pay patient, and payment is due at the time of the appointment. We do offer Membership and Payment Plans.
Credit Card on File
Craft Smiles Pediatric Dentistry requires parents to keep a credit card on file with our office. We use a secure credit card processing company, nadapayments. When your credit card is entered, your payment information will be stored on nadapayments secure server and available for future transactions. Our office staff will not have access to your card. A valid credit card, debit card, HSA, or FSA card will be accepted.
Your credit card on file will be used to pay account balances after insurance adjudication or provide refunds. Once your insurance processed your claims, they will send an Explanation of Benefits (EOB) to both you and our office showing your total patient responsibility. You typically receive the EOB before we do, so if you disagree with the patient responsibility amount owed, it is your responsibility to contact your insurance carrier immediately.
Our Insurance and Payment Policy states you are responsible for paying claims not covered by your insurance company. Having a credit card on file is another way to collect that payment. Nothing is changing about how much you pay. You will be sent a statement by mail, email, or text and/or notified by phone prior to any charges. Any outstanding balances over 30 days will be charged automatically or sent to our profit recovery company.
Privacy Consent
Under the Health Insurance and Portability and Accountability Act of 1996 (HIPAA), patients have certain rights to privacy regarding their Protected Health Information.
Parents should understand that the information can and will be used to:
- Conduct and direct my treatment among mutual healthcare providers who may be involved in that treatment directly and indirectly.
Obtain payment and billing for reimbursement for services and confirm coverage amongst third party payers. - Conduct normal health care operations.
- Please review more information about our Notice of Privacy Practices by clicking here. By signing the consent in our new patient forms, you agree that you have been given the right to read and review our Notice of Privacy Practices before signing the consent. Additionally, you understand that this organization has the right to change its Notice of Privacy Practices in the future.
You may request in writing that you have the ability to restrict how your private information is used or disclosed to carry out treatment, payment or healthcare operations. You also understand that you are not required to agree to the requested restrictions, but if you do agree, that you are bound to abide by such restrictions.
You may revoke your consent in writing at any time, except to the extent that you have acted relying on this consent.