Notice of Privacy Practices
This notice details how you or your child’s medical information may be used and disclosed and how you can access the information personally
Our Pledge to You
Our mission is to provide the highest quality, comfortable anesthesia services for patients in a dental setting. Sedadent Anesthesia Services (“we” or “Sedadent”) are committed to protecting your confidential health information. We perform privacy, and security assessments because we understand the privacy and security of your medical information is important to you.
This notice applies to Sedadent Anesthesia Services. We will comply with this notice with respect to how we disclose and use your medical and dental information. This does not apply to the treating office.
How We Use and Disclose Your Information
Sedadent Anesthesia Services uses your health and dental information to determine if and when anesthesia can be safely performed, to obtain payment for your treatment or to help you obtain reimbursement from your insurance, and for routine business operations. The following list contains some examples of ways we may use and disclose your health or dental information. We do not list all the ways we are permitted by law to use and disclose our information, but a use or disclosure should fall into one of the areas that follow:
How we use and disclose your information for treatment purposes: We use an electronic system to store your health information. We have in place security procedures and safeguards to protect the confidentiality of your electronic health & dental information. Our electronic records provide timely exchange of medical information needed for your treatment.
How we use and disclose your information to collect payment To obtain payment from Medicaid programs we may submit a claim to your health or dental insurance company.
How we use and disclose your information to help you receive insurance reimbursement We will collect our fees upfront. For those with private insurance carriers, we may submit a claim to your health or dental insurance company without accepting assignment, or deliver to you a health or dental claim form to submit to your insurance company for reimbursement of fees you paid to us according to your individual policy.
How we use and disclose your information for business operations We may call or leave a message for you about your appointment or to remind you that we need to speak to you about insurance information needed, or medical history clarifications when our doctors need to determine feasibility for treatment.
Ways we are required to disclose your information We may disclose your health information without your authorization when required to do so by federal, state, or local law. For example, we are required to do the following: report cases of suspected contagious disease and suspected child, elder, and spousal abuse; respond to court orders; comply with laws that relate to workers compensation or other similar programs established by law; report incidents related to adverse reactions to medication, medical devices or products; and comply by law with health oversight or law enforcement agencies.
Your Individual Rights
You have the right to:
Look at and ask for a copy of your health information as provided by law. Sedadent Anesthesia is allowed to charge a reasonable fee for making copies
Request that Sedadent contact you by alternate means, address, or telephone number to protect the privacy of confidential communications about your health care.
Request that we amend your health record, if you believe that your information is not correct or that your medical record is not complete. We will notify you if we are unable to honor your request.
Request that we restrict certain uses and disclosures of your information, unless the use or disclosure is otherwise permitted or required by law. We are not required to agree to your request unless you ask us to restrict the use and disclosure of your information to a health or dental plan for payment and the information you wish to restrict pertains solely to a health care item or service for which you have paid in full.
Receive an accounting of certain disclosures of your health information as provided by law
Ask for a paper copy of this privacy notice
If you sign an authorization allowing Sedadent to disclose your health information for reasons other than
treatment, payment, or healthcare operations, you can revoke your authorization at any time, except to the extent that we have taken action in reliance on it. You must revoke your authorization in writing to stop any future uses and disclosures.
Requests Must Be Submitted In Writing
Sedadent will consider your written requests. However, we may not be able to honor your request if law prevents it. If a request cannot be honored we will notify you in writing.
Sedadent’s Right to Change Our Privacy Notice
We may make changes to this notice at any time. Changes may result in additional uses or disclosures of your health information that are not previously authorized by you or mentioned in this notice. You may request a copy of the current Sedadent privacy notice in writing to the address provided at the end of our notice. You may also request a copy of our privacy notice from our staff.
Sedadent Responsibilities
State and Federal Law require us to protect the privacy of your health information, to provide you with a copy of this notice at your request, and to follow the terms stated in this notice. We are required to notify you of certain unauthorized access, acquisition, or use of your medical information. Sedadent maintains a website at www.iheartsedation.com that provides a link to a printable form of this notice. Our website offers a range of patient information and online services for your convenience. Except as described in this notice or otherwise permitted by law, Sedadent will not use or disclose your health information without your written authorization. Independent dental and medical providers who gather your health information are also required by law to protect the confidentiality of your health information.
For More Information or to Report a Problem
If you have any privacy related questions please contact our privacy officer by phone at (512) 909 3171
If you believe your privacy rights have been violated, you may contact our Privacy Officer in writing, Sedadent Anesthesia Services, Attention: Privacy Officer, 1608 Oak Forest Drive, Round Rock, TX 78681, or to file a complaint with the Office for Civil Rights, Office of Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, D.C. 20201. There will be no retaliation for filing a complaint.