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Hermanson Endodontics LLC

Pierre, SD

 
Financial
The fee for your endodontic treatment will be based on the extent of treatment. Endodontic fees usually range from $800 to $1,700 for a single tooth and it is our policy that your care is paid for at the time of treatment. The fee for endodontic therapy is determined by the complexity of the tooth being treated. Therefore, we may not be able to give an exact estimate of charges in advance of treatment. 
 
Many variables including location of your tooth, the procedure needed, and your insurance coverage will play a role. When you contact our office, we can discuss the probable number of visits, their length, and the fees involved. 

Hermanson Endodontics participates in the Delta Dental benefits plan.

  • If you are a member of this plan, please note the following:
    • If we are not able to estimate the out of pocket payment, 50% of the total estimated cost of treatment is due at the time of service.
      • If the insurance pays a greater amount a reimbursement check will be issued.
      • If the insurance pays less, a bill with the remaining unpaid balance will be sent.
    • You are responsible for any amounts over your yearly contracted benefit amount.
      • For example, if your total benefit is $1,000 and you have already submitted $1,000 of claims, you will be responsible for 100% of our fee.
    • You are responsible for knowing the rules and regulations of your insurance policy.
      • For example, not all dental or endodontic procedures are a covered benefit in all dental insurance plans.

If you are covered by WellMark Blue Cross Blue Shield, payment is due in full at time of service as WellMark Blue Cross Blue Shield sends any insurance payment directly to the patient.

If you are covered by any other dental plan, we will file an insurance claim on your behalf as a courtesy, but 50% payment is due at the time of service.

  • If the insurance pays a greater amount a reimbursement check will be issued.
  • If the insurance pays less, a bill with the remaining unpaid balance will be sent.

If your account becomes delinquent, the unpaid balance will be charged a 15% annual finance charge which will be applied monthly at 1.25%. At 180 days, any unpaid balance will be turned over to collections, and we may report the status and payment history of your account to credit reporting agencies.

 
We do accept Care Credit as a way for our patients to make payments on their treatment. If you feel like you would like to use this option we do require that you apply and are approved ahead of your appointment with us. 

 

  Click HERE for more information.

Privacy Policy - HIPPA

OUR LEGAL DUTY

We are required by applicable federal and state law to maintain the privacy of your health information.  We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information.  We must follow the privacy practices that are described in this Notice while it is in effect.  This Notice takes effect at the time of initial exam and will remain in effect until we replace it.

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law.  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 using the information listed at the end of this Notice.

USES AND DISCLOSURES OF HEALTH INFORMATION  

We use and disclose health information about you for treatment, payment, and healthcare operations.  For example:

Treatment:  We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.

Payment:  We may use and disclose your health information to obtain payment for services we provide to you. If you choose to pay for services rendered, in full, out of pocket you can request to restrict disclosure of that information including services rendered to your health insurance plan.

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 performance, conducting training programs, accreditation, certification, licensing or credentialing activities.

Your Authorization:  In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose.  If you give us an authorization, you may revoke it in writing at any time.  Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect.  Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this Notice.

To Your Family and Friends:  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.

Persons Involved In Care:  We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death.  If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures.  In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person's involvement in your healthcare.  We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information.

Sale of Personal Health Information: We will not disclose your protected health information without individual written authorization in exchange for remuneration.

Marketing Health-Related Services:  We will not use your health information for marketing communications without your written authorization.

Required by Law:  We may use or disclose your health information when we are required to do so by law.

Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes.  We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.

National Security:  We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances.  We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities.  We may disclose to correctional institution or law enforcement official having lawful custody of protected health information of inmate or patient under certain circumstances.

Appointment Reminders:  We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters).

PATIENT RIGHTS

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.  You must make a request in writing to obtain access to your health information.  You may obtain a form to request access by using the contact information listed at the end of this Notice. You may also request access by sending us a letter to the address at the end of this Notice.

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.

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). 

Alternative Communication:  You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. {You must make your request in writing.}  Your request must specify the alternative means or location and provide satisfactory explanation how payments will be handled under the alternative means or location you request.

Amendment:  You have the right to request that we amend your health information.  (Your 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 receive this Notice on our Web site or by electronic mail (e-mail), you are entitled to receive this Notice in written form. 

Breach Notification: If a breach of unsecured protected health information affects 500 or more individuals, our office with notify the Secretary of the breach without unreasonable delay and in no case later than 60 calendar days from discovery of the breach. If a breach of unsecured protected health information affects fewer that 500 individuals, our office will notify the Secretary of the break within 60 days of the end of the calendar year in which the breach was discovered.

QUESTIONS AND COMPLAINTS

If you want more information about our privacy practices or have questions or concerns, please contact us.

If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of this Notice.  You also may submit a written complaint to the U.S. Department of Health and Human Services.  We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.

We support your right to the privacy of your health information.  We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

Endodontic Informed Consent

This form briefly explains endodontic (root canal) treatment including some of the risks and benefits. Please read the following lines and feel free to discuss any aspect of your treatment, then sign electronically.

  1. Root canal treatment is a procedure that will allow me to keep a tooth that might otherwise have to be removed. An endodontic examination is performed to determine the specific need for root canal treatment. Which involves making an opening in the tooth, filling, or crown to remove damaged soft tissue that runs through the root; this space of tissue is then cleansed, and then sealed with a rubber like material.
  2.  Root canal treatment is usually successful. As with any branch of medicine or dentistry, no guarantee of success can be given. On occasion, a tooth that has received root canal therapy may require additional treatment or extraction at additional fees.
  3.  The number of visits, x-rays, photographs, or images may vary with the difficulty of the case.
  4.  Local anesthetics and a rubber dam will be used. In situations when the tissue in and around the root canal are extremely inflamed, obtaining profound anesthesia may be difficult.
  5.  Alternatives to performing root canal treatment are no treatment or extraction. No treatment leads to increasing pain, infection, bone and tissue destruction, and extraction may be necessary. Removal of a tooth may require other types of dental procedures at additional fees.
  6. Retreating a previous root canal or treating a root canal started in other dental offices may have different outcomes. There is no guarantee of success.
  7. Possible complications and challenges in root canal treatment, including but NOT limited 

to:

            - Curved canals or roots                                                - Crown or root fracture

- Calcification in root canal space                                - Pain during or following treatment

- Swelling or discoloration of soft and/or hard tissues

- Procedural difficulties such as:

  • Instrument separation
  • Root perforation
  • Overextension of the filling material
  1. Periodic re-evaluation of the tooth is recommended following the completion of the root canal treatment.
  2. If I discontinue treatment at any time and root canal treatment is not completed, retention of the tooth might be compromised. Pain, swelling, infection, extraction and other treatment may result with additional fees.
  3.  Emergency service is available by calling Hermanson Endodontics at (605)220-8222.

I understand that after root canal treatment, the tooth will always need a new filling or crown. In addition to a final restoration (permanent filling or crown), I understand that other dental procedures such as a crown lengthening, post and core, foundation, etc., may be necessary. The costs of these procedures will be charged separately from the charges for

endodontic treatment.

After root canal treatment the new filling or crown must be placed as soon as possible.

I have read and understand the Hermanson Endodontics Endodontic Informed Consent and I consent to the policy. Signature of consent is acquired and saved electronically.