Our Policies

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information.  We must follow the privacy practices that are described in this Notice while its in effect.  This Notice takes effect February 16, 2026 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, and to make the new Notice provisions effective for all protected health information that we maintain.  When we make a significant change in our privacy practices, we will change this Notice and post the new Notice clearly and prominently at our practice location, and we will provide copies of the new Notice 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.

`HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

We may use and disclose your health information for different purposes, including treatment, payment, and health care operations.  For each of these categories, we have provided a description and an example.  Some information, such as HIV-related information, genetic information, alcohol and/or substance use disorder treatment records, and mental health records may be entitled to special confidentiality protections under applicable state or federal law.  We will abide by these special protections as they pertain to applicable cases involving these types of records.

1.   We may use and disclose your health information for your treatment.  For example, we may disclose health information to a specialist providing treatment to you.
2. We may use and disclose your health information to obtain reimbursement for the treatment and services you receive from us or another entity involved in your care.  Payment activities include billing, collections, claim management, and determinations of eligibility and coverage to obtain payment from you, and insurance company, or another 3^rd party.  For example, we may send claims to your dental health plan containing certain health information.

Healthcare Operations.  We may use and disclose your health information in connection with our healthcare operations.  For example, healthcare operations include quality assessment and improvement activities, conducting training programs, and licensing activities.

Individuals Involved in Your Care or Payment of  Your Care.  We may disclose your health information to your family, friends or any other individual identified by you when they participate in your care or in the payment for your care.  Additionally, we may disclose information about you to a patient representative.  If a person has the authority by law to make health care decisions for you, we will treat that patient representative the same way we would treat you with respect to your health information.

Disaster Relief.  We may use or disclose your health information to assist in disaster relief efforts.

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

Public Health Activities.  We may disclose your health information for public health activities, including disclosures to:

• Prevent or control disease, injury or disability;
• Report child abuse or neglect;
• Report reactions to medications or problems with products or devices;
• Notify a person of recall, repair,  or replacement of products or devices;
• Notify a person who may have been exposed to disease or condition; or
• Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence

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 officials having lawful custody the protected health information of an inmate or patient.

Secretary of HHS.  We will disclose your health information to the Secretary of the U.S. Department of Health and Human Services when required to investigate or determine compliance with HIPAA.

Worker’s Compensation.  We may disclose your PHI to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.

Law Enforcement.  We may disclose your PHI for law enforcement purposes as permitted by HIPAA, as required by law, or in response to a subpoena or court order.

Health Oversight Activities.  We may disclose your PHI to an oversight agency for activities authorized by law.  These oversight activities include audits, investigations, inspections, and credentialing, as necessary for licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Judicial and Administrative Proceedings.  If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order  We may also disclose health information  about you in response to  a subpoena, discovery request, or other lawful process instituted by someone else involved in the dispute, but only if efforts have been made, either by the requesting party or us, to tell you about the request or to obtain an order protecting the information requested.

1.   We may disclose your PHI to researchers when their research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your information.

Coroners, Medical Examiners, and Funeral Directors.  We may release your PHI to a coroner or medical examiner.  This may be necessary, for example, to identify a deceased person or determine cause of death.  We may also disclose PHI to funeral directors consistent with applicable law to enable them to perform their duties.

1. We may contact you to provide you with information about our sponsored activities, including fundraising programs, as permitted by applicable law.  If you do not wish to receive such information from us, you may opt out of receiving communications.

SUD Treatment Information.  If we receive or maintain any information about you from a substance use disorder treatment program that is covered by 42 CFR Part 2 (a “Part 2 Program”) through a general consent you provide to the Part 2 Program to use and disclose the Part 2 Program record for purposes of treatment, payment or health care operations, we may use and disclose your Part 2 Program record for treatment, payment and healthcare operations purposes as described in this Notice.  If we receive or maintain your Part 2 Program record through specific consent you provide to us or another third party, we will use and disclose your Part 2 Program record only as expressly permitted by you in your consent as provided to us.

In no event will we use or disclose your Part 2 Program record, or testimony that describes the information contained in your Part 2 Program record, in any civil, criminal, administrative, or legislative  proceedings by any Federal, State, or local authority, against you, unless authorized by your consent or the order of a court after it provides you notice of the court order.

OTHER USES AND DISCLOSURES OF PHI

Your authorization is required, with a few exceptions, for disclosure of psychotherapy notes, use or disclosure of PHI for marketing, and for sale of the PHI.  We will also obtain your written authorization before using or disclosing your PHI for purposes other than those provided for in this Notice (or as otherwise permitted or required by law).  You may revoke an authorization in writing at any time.  Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent that we have already acted in reliance on the authorization.

YOUR HEALTH INFORMATION RIGHTS

1. You have the right to look at  or get copies of your health information, with limited exceptions.  You must make the request in writing.  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.  If you request information that we maintain on paper, we may provide photocopies.  If you request information that we maintain electronically, you have the right to  an electronic copy.  We will use the form and format you request if readily producible.  We will charge you a reasonable cost-based fee for the cost of supplies and labor of copying, and for the postage if you want the copies mailed to you.  Contact us using the information listed at the end of this Notice for an explanation of our fee structure.

If you are denied a request for access, you have the right to have the denial reviewed in accordance with the requirements of applicable law.

Disclosure Accounting.  With the exception of certain disclosures, you have the right to receive an accounting of disclosures of your health information in accordance with applicable laws and regulations. To request an accounting  of disclosures of your health information, you must submit your request in writing to the Privacy Official.  If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to the additional requests.

Right to Request a Restriction.  You have the right to request additional restrictions on our use or disclosure of your PHI by submitting a written request to the Privacy Official.  Your written request must include:  (1) what information you want to limit (2) whether you want to limit our use, disclosure or both and (3) to whom you want the limits apply.  We are not required to agree to your request except in the case where the disclosure is to a health plan for purposes of carrying out payment or health care operations, and the information pertains solely to a health care item or service for which you, or a person on your behalf (other than the health plan) has paid our practice in full.

Alternative Communication.  You have the right to request that we communicate with you about your health information by alternative means or at alternative locations.  You must make your request in writing.  Your request must specify the alternative means or location and provide satisfactory explanation of how payments will be handled under the alternative means or location you request.  We will accommodate all the reasonable requests.  However, if we are unable to contact you using the ways or locations you have requested. We may contact you using the information we have.

1. 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.  If we agree to your request, we will amend your record(s) and notify you of such.  If we deny your request, we will provide you with a written explanation of why we denied it and explain your rights.

Right to Notification of a Breach.  You will receive notification of breaches of your unsecured protected health information as required by law.

Electronic Notice.  You may receive a paper copy of this Notice upon request, even if you have agreed to receive this Notice electronically on our website or by e-mail.

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 if you disagree with a decision we made about access to your health information or in response to a request you made, you may complain to us using the contact information listed at the end of this Notice.  You may also 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 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.

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CONTACT INFORMATION

Crosswinds Dental

 515 Executive Campus Drive Suite 160

Westerville, Ohio 43082

office@crosswindsdental.com

614-890-3130

614-890-8466 (fax)

Dental Insurance is a contract between you and your insurance company. It is your responsibility to understand the extent and limits of your coverage, and to provide our staff with accurate information to process your claim efficiently (i.e. insurance company address, phone number, etc.). We require you to update your insurance information one time per year to assure accurate information is being submitted to the insurance. It is not our place to enter into disputes between you and your insurance company regarding deductibles, copayments, etc. other than to provide factual information. We do not directly participate with most Insurance programs; however, as a courtesy, we do process your claim for payment to be made directly to you. Certain conditions may apply to your financial arrangements that may require your authorization for release and assignment of benefits. If we do not participate with your insurance, 100% of the total cost is requested at the time of treatment. If you are unable to pay 100%, affordable payment options are available. Our staff will help you process whatever paperwork is required. However, the ultimate responsibility lies with you for payment of any and all monies due.

We are committed to providing you with the best possible care, and are pleased to discuss our professional fees with you at any time. Your clear understanding of our Financial Policy is important to us. Before beginning any treatment, we will discuss with you any fees and payments that may be due so that you will know what to expect at your next appointment. We will research your individual dental benefits and give you an estimate on coverage. We are happy to submit claims to your insurance on your behalf so that we may maximize your dental benefits for the year. However, we CANNOT guarantee our estimate and you ARE responsible for any remaining balance. Payment is due at the time of service.