HIPPA – Notice of Privacy Practices
Spartanburg Pediatric Dentistry Office Policies
Welcome to Spartanburg Pediatric Dentistry (SPD). We thank you for trusting us with the most
precious people in your life, your children. We work hard each day to use the gift of service that
God has given each of us to care for your family. We believe to be clear is to be kind, so below
you will find our policies that will help you as you move forward. We would love to speak with
you, if you have any further questions.
Appointment Policy:
Your child’s appointment time is reserved for their dental care. This time is used to provide
treatment as well as discuss any questions or concerns parents/guardians may have. To
ensure that all patients have this time, if you are more than 10 minutes late for your
appointment time, your appointment may be rescheduled. If you are running behind, please
communicate so that we can determine whether there is adequate time to care for your child.
SPD requires a 24 hours notice to change your appointment time. However, life happens and
children get sick unexpectedly. Your communication is critical, please call our office to
reschedule ASAP. Not showing for a scheduled appointment WITHOUT communication may
revoke your scheduling privileges
Family Dynamics:
We realize that family dynamics vary greatly from family to family. Our intention is to clarify who
is responsible for treatment decisions and payment. When completing the new patient
paperwork, there will be questions that specifically ask who has the right to give consent for
treatment. If someone other than the legal parent/guardian is bringing your child, you must call
our office to give consent before treatment can be performed.
If there is court documentation that directs that a parent/guardian can not make dental treatment
decisions, it is the parent/guardian’s responsibility to give that documentation to SPD. Without
this documentation BOTH parents have access to their child’s account information. It is the
responsibility of the parties sharing custody to communicate treatment plans, appointments, and
payments PRIOR to the child’s dental appointment.
Medicaid Policy:
Currently, we are NOT accepting any new Medicaid patients at this time, unless they are
referred by another dental provider for treatment under sedation. The referring provider will
contact our office directly to set that appointment up with our team.
SPD accepts South Carolina Medicaid ONLY. It is the parent/guardian’s responsibility to
provide SPD with the most current Medicaid information. If your child is ineligible at the time of
service, we will reschedule the appointment for an eligible date.
Insurance and Payment Policy:
For our patient’s who do NOT have insurance, we offer a courtesy discount when paying in
FULL for treatment.
10% discount if paid in FULL by cash/check/credit card or debit card
Fees are due and payable when services are rendered. For your convenience, we accept cash,
check, Visa, Mastercard, and Care Credit. A payment plan may also be arranged if you
communicate financial hardships.
Your dental insurance policy is a contract between you and your insurance company. SPD will
file insurance on your behalf as a courtesy. SPD files to ALL insurance companies, however
we are not an “in-network” provider for any insurance company.
Prior to your child’s appointment, we will call your insurance company to verify your benefits.
We will ESTIMATE the cost of your child’s treatment based on what your insurance company
quotes us. Depending on your insurance plan benefits, plans often cover only a PORTION of
the actual cost of dental treatment or there are services that are NOT covered by dental
insurance. By asking SPD to file insurance on your behalf, you are agreeing to pay the full
amount regardless of what insurance agrees to pay. Please contact your insurance company
directly for detailed benefit information. It is the parent/guardian's responsibility to be aware of
their dental coverage.
Some insurance companies pay the policy holder directly, instead of the dental office. For those
insurance types, we will require PAYMENT UPFRONT before treatment is completed. We will
file your insurance on the day of service and within approximately 2 weeks, your insurance
company will reimburse you for the covered portion of treatment directly.
Cost for treatment is an ESTIMATE based upon your insurance coverage, and anything not
covered by insurance will be your responsibility.
Patients that have an outstanding balance will NOT be permitted to schedule an appointment
until the balance is paid in full.
Kindness Policy:
We treat each other and our patients with kindness and respect each day. We expect that
parents/guardians also treat our team with the same kindness and respect. We will dismiss
anyone from our practice who choses to communicate disrespectfully to our team.
Spartanburg Pediatric Dentistry
Spartanburg, SC 29307
(864)699-9193